Abstract
Background:
NMB use in ARDS has been shown to improve oxygenation and reduce mortality.1,2 However, its use has been associated with intensive care unit (ICU) -acquired weakness and increased days of mechanical ventilation (MV). 2 Therefore, we inquired whether NMB use in our ARDS patients impacted duration of mechanical ventilation (DMV).
Methods:
Our ARDS quality assurance database was queried between March 2010 and December 2017 to identify subjects who received NMB. As this was a preliminary inquiry for an anticipated more in-depth retrospective study, we addressed the problem of controlling for confounding variables by using a case-control approach. Three inclusion criteria were used: 1) ARDS onset had to occur within 1 calendar day of initiating MV, 2) a minimum DMV of 5 days (ie, the 25% quartile of all ARDS survivors with a lung injury score [LIS] > 3), and 3) survival at hospital discharge. Three matching criteria were used: 1) gender, 2) exact LIS match calculated at ARDS onset and, 3) either an acute physiology and chronic health evaluation score (APACHE II) within 5 points, or a simplified acute physiology score (SAPS II) within 10 points; both of which were calculated at ARDS onset.
Results:
There was no difference between those subjects who received NMB and controls in terms of: 1) total DMV 2) ARDS related DMV, 3) ICU Length of Stay (LOS), or 4) Post-ICU LOS. Matching was successful as indicated by lack of difference in illness severity scores and LIS; however, control patients were significantly older.
Conclusions:
In a matched group of patients with relatively severe ARDS (median LIS = 3), use of NMB had no impact on DMV, LOS, or Post-ICU LOS. This data is the basis for further in-depth study on the impact of NMB dose and duration on these outcome variables.
1. Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 2010;363:1107-1116. 2. Hraiech S, Forel JM, Papazian L. The role of neuromuscular blockers in ARDS: benefits and risks. Curr Opin Crit Care 2012;18:495-502.
LOS = length-of-stay View all access options for this article.
NMB
Control
P
N
35
35
Age
43 [33,54]
53 [43,69]
0.005
LIS
3 [2,3]
3 [2,3]
>0.99
APACHE II
21 [17,27]
22 [16,28]
0.98
SAPS II
45 [36,60]
46 [37,57]
0.99
ICU Days to MV
0 [0,1]
0 [0,0]
0.99
Days MV to ARDS
0 [0,0]
0 [0,0]
1
Total MV Days
11 [7,18]
10 [7,19]
0.64
ARDS MV Days
11 [7,17]
10 [7,18]
0.57
ICU LOS
16 [11,23]
13 [9,23]
0.69
Post ICU LOS
13 [3,25]
13 [6,23]
0.86
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