TY - JOUR
T1 - Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS
T2 - a propensity score analysis
AU - the COVID-19 Critical Care Consortium
AU - Li Bassi, Gianluigi
AU - Gibbons, Kristen
AU - Suen, Jacky Y.
AU - Dalton, Heidi J.
AU - White, Nicole
AU - Corley, Amanda
AU - Shrapnel, Sally
AU - Hinton, Samuel
AU - Forsyth, Simon
AU - Laffey, John G.
AU - Fan, Eddy
AU - Fanning, Jonathon P.
AU - Panigada, Mauro
AU - Bartlett, Robert
AU - Brodie, Daniel
AU - Burrell, Aidan
AU - Chiumello, Davide
AU - Elhazmi, Alyaa
AU - Esperatti, Mariano
AU - Grasselli, Giacomo
AU - Hodgson, Carol
AU - Ichiba, Shingo
AU - Luna, Carlos
AU - Marwali, Eva
AU - Merson, Laura
AU - Murthy, Srinivas
AU - Nichol, Alistair
AU - Ogino, Mark
AU - Pelosi, Paolo
AU - Torres, Antoni
AU - Ng, Pauline Yeung
AU - Fraser, John F.
AU - Al-Dabbous, Tala
AU - Alfoudri, Huda
AU - Shamsah, Mohammed
AU - Elapavaluru, Subbarao
AU - Berg, Ashley
AU - Horn, Christina
AU - Mayasi, Yunis
AU - Schroll, Stephan
AU - Meyer, Dan
AU - Velazco, Jorge
AU - Ploskanych, Ludmyla
AU - Fikes, Wanda
AU - Bagewadi, Rohini
AU - Dao, Marvin
AU - White, Haley
AU - Meyer, Dan
AU - Ehlers, Ashley
AU - Shalabi-McGuire, Maysoon
AU - Witt, Trent
AU - Grazioli, Lorenzo
AU - Lorini, Luca
AU - Grandin, E. Wilson
AU - Nunez, Jose
AU - Reyes, Tiago
AU - OBriain, Diarmuid
AU - Hunter, Stephanie
AU - Ramanan, Mahesh
AU - Affleck, Julia
AU - Veerendra, Hemanth Hurkadli
AU - Rai, Sumeet
AU - Russell-Brown, Josie
AU - Nourse, Mary
AU - Joseph, Mark
AU - Mitchell, Brook
AU - Tenzer, Martha
AU - Abe, Ryuzo
AU - Cho, Hwa Jin
AU - Jeong, In Seok
AU - Rahman, Nadeem
AU - Kakar, Vivek
AU - Brozzi, Nicolas
AU - Mehkri, Omar
AU - Krishnan, Sudhir
AU - Duggal, Abhijit
AU - Houltham, Stuart
AU - Graf, Jerónimo
AU - Diaz, Roderigo
AU - Orrego, Roderigo
AU - Delgado, Camila
AU - González, Joyce
AU - Sanchez, Maria Soledad
AU - Piagnerelli, Michael
AU - Sarrazin, Josefa Valenzuela
AU - Zabert, A. /Prof Gustavo
AU - Espinosa, Lucio
AU - Delgado, Paulo
AU - Delgado, Victoria
AU - Rincón, Diego Fernando Bautista
AU - Yanten, Angela Maria Marulanda
AU - Duque, Melissa Bustamante
AU - Brodie, Daniel
AU - Elhazmi, Alyaa
AU - Al-Hudaib, Abdullah
AU - Callahan, Maria
AU - Taufik, M. Azhari
AU - Wardoyo, Elizabeth Yasmin
AU - Gunawan, Margaretha
AU - Trisnaningrum, Nurindah S.
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12/1
Y1 - 2022/12/1
N2 - 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.
AB - 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.
KW - COVID-19
KW - Intensive care unit
KW - Mechanical ventilation
KW - Neuromuscular blocking agent
KW - SARS-CoV-2
KW - Aged
KW - Female
KW - Humans
KW - Intensive Care Units
KW - Male
KW - Middle Aged
KW - Neuromuscular Blocking Agents/therapeutic use
KW - Propensity Score
KW - Respiration, Artificial
KW - Respiratory Distress Syndrome/drug therapy
KW - COVID-19 Drug Treatment
UR - https://www.scopus.com/pages/publications/85130163070
U2 - 10.1186/s13054-022-03983-5
DO - 10.1186/s13054-022-03983-5
M3 - Article
C2 - 35581612
AN - SCOPUS:85130163070
SN - 1364-8535
VL - 26
SP - 141
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 141
ER -
SDG 3 Good Health and Well-being