Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis

Critical Care

The COVID-19 Critical Care Consortium¹  John G. Laffey²  Alistair Nichol³  Aidan Burrell³  Carol Hodgson³  Kristen Gibbons⁴  John F. Fraser⁵  Jacky Y. Suen⁵  Amanda Corley⁵  Gianluigi Li Bassi⁵  Jonathon P. Fanning⁵  Daniel Brodie⁶  Pauline Yeung Ng⁷  Srinivas Murthy⁸  Paolo Pelosi⁹  Mauro Panigada^1,10  Mariano Esperatti^1,11  Heidi J. Dalton^1,12  Laura Merson^1,13  Antoni Torres^1,14  Giacomo Grasselli^1,15  Eddy Fan^1,15  Alyaa Elhazmi^1,16  Eva Marwali^1,17  Mark Ogino^1,18  Carlos Luna^1,19  Shingo Ichiba^2,20  Davide Chiumello^2,21  Nicole White^2,22  Robert Bartlett^2,23  Sally Shrapnel^2,24  Simon Forsyth^2,24  Samuel Hinton^2,24 

[1] ;Anaesthesia and Intensive Care Medicine, School of Medicine, National University of Ireland, and Galway University Hospitals;Australian and New Zealand Intensive Care Research Centre, School of Public Health, Monash University;Child Health Research Centre, The University of Queensland;Critical Care Research Group, The Prince Charles Hospital;Department of Medicine, Columbia College of Physicians and Surgeons, and Center for Acute Respiratory Failure, New-York-Presbyterian Hospital;Department of Medicine, The University of Hong Kong;Department of Pediatrics, Faculty of Medicine, University of British Columbia;Department of Surgical Sciences and Integrated Diagnostics, University of Genoa;Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico di Milano;Hospital Privado de Comunidad, Escuela de Medicina, Universidad Nacional de Mar del Plata;INOVA Fairfax Medical Center, Heart and Vascular Institute;ISARIC, Centre for Tropical Medicine and Global Health, University of Oxford;Institut dInvestigacions Biomèdiques August Pi i Sunyer;Interdepartmental Division of Critical Care Medicine, University of Toronto;King Faisal Specialist Hospital and Research Centre;National Cardiovascular Center Harapan Kita;Nemours Alfred I duPont Hospital for Children;Neumonología, Hospital de Clínicas, UBA;Nippon Medical School Hospital;Ospedale San Paolo;Queensland University of Technology;University of Michigan Medical Center;University of Queensland;

关键词: SARS-CoV-2;    COVID-19;    Neuromuscular blocking agent;    Mechanical ventilation;    Intensive care unit;   

DOI  :  10.1186/s13054-022-03983-5

来源: DOAJ

【 摘 要 】

Abstract Background The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis. Methods We analyzed a convenience sample of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2 days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48 h from commencement of IMV were compared with subjects who did not receive NMBAs or only upon commencement of IMV (control). The primary objective in the PS-matched cohort was comparison between groups in 90-day in-hospital mortality, assessed through Cox proportional hazard modeling. Secondary objectives were comparisons in the numbers of ventilator-free days (VFD) between day 1 and day 28 and between day 1 and 90 through competing risk regression. Results Data from 1953 patients were included. After propensity score matching, 210 cases from each group were well matched. In the PS-matched cohort, mean (± SD) age was 60.3 ± 13.2 years and 296 (70.5%) were male and the most common comorbidities were hypertension (56.9%), obesity (41.1%), and diabetes (30.0%). The unadjusted hazard ratio (HR) for death at 90 days in the NMBA treatment vs control group was 1.12 (95% CI 0.79, 1.59, p = 0.534). After adjustment for smoking habit and critical therapeutic covariates, the HR was 1.07 (95% CI 0.72, 1.61, p = 0.729). At 28 days, VFD were 16 (IQR 0–25) and 25 (IQR 7–26) in the NMBA treatment and control groups, respectively (sub-hazard ratio 0.82, 95% CI 0.67, 1.00, p = 0.055). At 90 days, VFD were 77 (IQR 0–87) and 87 (IQR 0–88) (sub-hazard ratio 0.86 (95% CI 0.69, 1.07; p = 0.177). Conclusions In patients with COVID-19 and moderate-to-severe ARDS, short course of NMBA treatment, applied early, did not significantly improve 90-day mortality and VFD. In the absence of definitive data from clinical trials, NMBAs should be indicated cautiously in this setting.

【 授权许可】

Unknown