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

  • Li Bassi, Gianluigi Luigi I.; 
  • Gibbons, Kristen Stacey; 
  • Suen, Jacky Y.; 
  • Dalton, Heidi Jean; 
  • White, Nicole M.; 
  • ... Jung, Hanna; 
  • 외 679명
Citations

SCOPUS

13

초록

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. © 2022, The Author(s).

키워드

COVID-19; Intensive care unit; Mechanical ventilation; Neuromuscular blocking agent; SARS-CoV-2
제목
Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis
저자
Li Bassi, Gianluigi Luigi I.; Gibbons, Kristen Stacey; Suen, Jacky Y.; Dalton, Heidi Jean; White, Nicole M.; Corley, Amanda; Shrapnel, Sally; Hinton, Samuel R.; Forsyth, Simon J.; Laffey, John Gerard; Fan, Eddy; Fanning, Jonathon Paul; Panigada, Mauro; Bartlett, Robert H.; Brodie, Daniel M.; Burrell, Aidan J.C.; Chiumello, Davide Alberto; Elhazmi, Alyaa M.; Esperatti, Mariano; Grasselli, Giacomo S.; Hodgson, Carol L.; Ichiba, Shingo; Luna, Carlos Marcelo; Marwali, Eva M.; Merson, Laura; Murthy, Srinivas N.Krishna; Nichol, Alistair D.; Ogino, Mark T.; Pelosi, Paolo P.; Torres, Antoni; Ng, Paulineyeung; Fraser, John F.; Al-Dabbous, Tala; Alfoudri, Huda; Shamsah, Mohammed A.; Elapavaluru, Subbarao; Berg, Ashley; Horn, Christina; Mayasi, Yunis M.; Schroll, Stephan; Meyer, Dan Marshall; Velazco, Jorge Francisco; Ploskanych, Ludmyla; Fikes, Wanda; Bagewadi, Rohini; Dao, Marvin; White, Haley; Meyer, Dan; Ehlers, Ashley; Shalabi-McGuire, Maysoon; Witt, Trent; Grazioli, Lorenzo Stephan Cesare; Lorini, Ferdinando Luca; Grandin, Edward Wilson; Nunez, Jose I.; Reyes, Tiago; O’Briain, Diarmuid; Hunter, Stephanie; Ramanan, Mahesh; Affleck, Julia; Veerendra, Hemanth Hurkadli; Rai, Sumeet S.; Russell-Brown, Josie; Nourse, Mary; Joseph, Mark; Mitchell, Brook; Tenzer, Martha M.; Abe, Ryuzo; Cho, Hwa-jin; Jeong, Inseok; Rahman, Nadeem M.; Kakar, Vivek; Brozzi, Nicolas Ariel; Mehkri, Omar; Krishnan, Sudhir; Duggal, Abhijit; Houltham, Stuart; Graf, Jerónimo; Diaz, Roderigo; Orrego, Roderigo; Delgado, Camila; González, Joyce; Sanchez, Maria Soledad; Piagnerelli, Michaël; Sarrazin, Josefa Valenzuela; Zabert, A. Prof Gustavo; Espinosa, Lucio F.; Delgado, Paulo; Delgado, Victoria; Rincón-Rodríguez, Diego Fernando Bautista; Yanten, Angela Maria Marulanda; Duque, Melissa Bustamante; Brodie, Daniel; Al-Hudaib, Abdullah; Callahan, Maria C.; Taufik, Muhammad Azhari; Wardoyo, Elizabeth Y.; Gunawan, Margaretha; Trisnaningrum, Nurindah Saloka; Irawany, Vera; Rayhan, Muhammad A.; Pesenti, Antonio Maria; Zanella, Alberto; Leone, Michela; Coppola, S.; Colombo, Sebastiano Maria; Antonelli, Massimo M.; Carelli, Simone; Grieco, Domenico Luca; Asaki, Motohiro; Hoshino, Kota; Salazar, Leonardo Alberto; Duarte, Laura; McNicholas, Bairbre Aine; Cosgrave, David W.; McCaffrey, Joseph; Bone, Allison; Hakeem, Yusuff; Winearls, James Roger; Tallott, Mandy; Thomson, David A.; Arnold-Day, Christel; Cupido, Jerome; Miller, Malcolm G.A.; Seymore, Lisa; van Straaten, Dawid; Ait Hssain, Ali; Aliudin, Jeffrey; Alqahtani, Al Reem; Mohamed, Khoulod; Mohamed, Ahmed Ibrahim; Tan, Darwin; Villanueva, Joy Ann; Zaqout, Ahmed; Kurtzman, Ethan; Ademi, Arben; Dobrita, Ana; El Aoudi, Khadija; Segura, Juliet; Giwangkancana, Gezy Weita; Ohshimo, Shinichiro; Hoshino, Koji; Saito, Hitoshi; Osatnik, Javier D.; Joosten, Anne; Yang, Minlan; Motos, A.; Arancibia, Francisco E.; Williams, Virginie; Noel, Alexandre; Luque, Nestor; Trung, Trieu Huynh; Yacoub, Sophie; Fantini, Marina; García, Ruth Noemi Jorge; Chicote-Álvarez, Enrique; Greti, Anna; Ceccato, A.; Sanchez, Angel Gabriel; Vázquez, Ana Loza; Roche-Campo, Ferrán; Franch-Llasat, Diego; Tuazon, Divina M.; Amato, Marcelo Britto Passos; Cassimiro, Luciana; Pola, Flavio; Ribeiro, Francis; da Fonseca, Guilherme Wesley Peixoto; Desai, Mehul A.; Osborn, Erik; Deeb, Hala Hasan; Arcadipane, Antonio F.; Martucci, Gennaro; Panarello, Giovanna; Vitiello, Chiara; Bianco, Claudia; Occhipinti, Giovanna; Rossetti, Matteo; Cuffaro, Raffaele; Cho, Sung-min ‑m; Shimizu, Hiroaki; Moriyama, Naoki; Kim, Jaeburm; Kitamura, Nobuya; Gebauer, Johannes; Yokoyama, Toshiki; Al-Fares, Abdulrahman Abdullah; Buabbas, Sarah Fadel; Alamad, Esam; Alawadhi, Fatma; Alawadi, Kalthoum; Tanaka, Hiro; Hashimoto, Satoru; Yamazaki, Masaki; Oh, Takhyuck; Epler, Mark; Forney, Cathleen; Kruse, Louise; Feister, Jared; Williamson, Joelle; Grobengieser, Katherine O.; Gnall, Eric M.; Golden, Sasha; Caroline, Mara; Shapiro, Timothy A.; Karaj, Colleen; Thome, Lisa; Sher, Lynn; Vanderland, Mark; Welch, Mary; McDermott, Sherry; Brain, Matthew J.; Mineall, Sarah; Kimura, Dai; Brazzi, Luca; Sales, Gabriele; Ogston, Tawnya; Nagpal, A. Dave; Fischer, Karlee; Lorusso, Roberto R.; Rangappa, Rajavardhan; Rai, Sujin; Appu, Argin; Esperatti, Mariano; Carton, Edmund G.; Sen, Ayan; Palacios, Amanda; Rainey, Deborah; Samoukoviv, Gordan; Campisi, Josie; Durham, Lucia; Neumann, Emily; Seefeldt, Cassandra; Falcucci, Octavio A.; Emmrich, Amanda D.; Guy, Jennifer; Johns, Carling; Potzner, Kelly; Zimmermann, Catherine; Espinal, Angelia; Buchtele, Nina; Schwameis, Michael; Stecher, Stephanie Susanne; Singh, Delila; Barnikel, Michaela; Arenz, Lukas; Zaaqoq, Akram M.; Galloway, Lan Anh S.; Merley, Caitlin; Csete, Marc; Quesada, Luisa; Saba, Isabela C.; Kasugai, Daisuke; Hiraiwa, Hiroaki; Tanaka, Taku; Purnama, Yoel; Dewayanti, Santi Rahayu; Ardiyan; Juzar, Dafsah Arifa; Siagian, Debby; Chen, Yih Sharng; Rätsep, Indrek; Oigus, Getter; Erikson, Kristo; Post, Andra Maris; Enneveer, Lauri; Sillaots, Piret; Manetta, Frank; Mihelis, Efstathia A.; Sarmiento, Iam Claire E.; Narasimhan, Mangala; Varrone, Michael; Komats, Mamoru; Garcia-Diaz, Julia B.; Harmon, Catherine; Satyapriya, Sree Veena; Bhatt, Amar M.; Mokadam, Nahush Ashok; Uribe, Alberto; González, Alicia Encabo; Shi, Haixia; McKeown, Johnny; Pasek, Joshua; Fiorda, Juan; Echeverria, Marco; Moreno, Rita; Zakhary, Bishoy M.; Cavana, Marco; Cucino, Alberto; Foti, Giuseppe; Giani, Marco; Russotto, Vincenzo; Castagna, Valentina; Dell’amore, Andrea; Navalesi, Paolo; Shum, Hoiping; Vuysteke, Alain; Usman, Asad Ali; Acker, Andrew M.; Smood, Benjamin F.; Mergler, Blake D.; Sertic, Federico; Subramanian, Madhu; Sperry, Alexandra E.; Rizer, Nicholas W.; Burhan, Erlin A.; Rasmin, Menaldi R.; Akmal, Ernita; Sitompul, Faya Nuralda; Lolong, Navy; Naivedh, Bhat; Erickson, Simon J.; Barrett, Peter W.; Dean, David; Daugherty, Julia; Loforte, Antonio; Khan, Irfan; Abraar Quraishi, Mohammed; DeSantis, Olivia; So, Dominic H.K.; Kandamby, Darshana Hewa; Mandei, Jose Meky; Natanael, Hans; YudhaLantang, Eka; Lantang, Anastasia; Wijaya, Surya Otto; Jung, Anna; Ng, George Wing Yiu; Ng, Wingyiu George; Fang, Shu; Tabah, Alexis; Ratcliffe, Megan; Duroux, Maree A.; Adachi, Shingo; Nakao, Shota; Blanco, Pablo; Prieto, Ana María; Sánchez, Jesús; Nicholson, Meghan; Butt, Warwick Wolf; Serratore, Alyssa; Delzoppo, Carmel; Janin, Pierre F.; Yarad, Elizabeth A.; Totaro, Richard J.; Coles, Jennifer; Pujo, Bambang; Balk, Robert A.; Vissing, Andrew; Kapania, Esha Madhu; Hays, James F.; Fox, Samuel; Yantosh, Garrett; Mishin, Pavel; Yuliarto, Saptadi; Hari Santoso, Kohar; Djajalaksana, Susanthy; Fatoni, Arie Zainul; Fukuda, Masahiro; Liu, Keibun; Battaglini, Denise; Jiménez, Juan Fernando Masa; Bastos, Diego; Gaião, Sérgio Mina; Rusmawatiningtyas, Desy; Buchner, Jessica A.; Cho, Young-jae; Lee, Su-hwan; Kawasaki, Tatsuya; Munshi, Laveena; Sakiyalak, Pranya; Nitayavardhana, Prompak; Seitz, Tamara; Arora, Rakesh C.; Kent, David M.; Marino, Daniel; Parwar, Swapnil; Cheng, Andrew; Miller, Jennene J.; Fujitani, Shigeki; Shimizu, Naoki; Madhok, Jai; Owyang, Clark G.; Buscher, Hergen; Reynolds, Claire; Maasikas, Olavi; Beljantsev, Aleksandr; Mihnovits, Vladislav; Akimoto, Takako; Aizawa, Mariko; Horibe, Kanako; Onodera, Ryota; Young, Meredith E.; George, Timothy Jacob; Shekar, Kiran V.; McGuinness, Niki; Irvine, Lacey; Flynn, Brigid C.; Endo, Tomoyuki; Sugiyama, Kazuhiro; Shimizu, Keiki; Exconde, Kathleen; Lussier, Leslie; Lotz, Gösta; Malfertheiner, Maximilian Valentin; Maier, Lars Siegfrid; Dreier, Esther; Kusumastuti, Neurinda Permata; McCloskey, Colin G.; Dabaliz, Al Awwab Mohammad; Elshazly, Tarek B.; Smith, Josiah; Szułdrzyński, Konstanty S.; Bielanski, Piotr; Wille, Keith M.; Parhar, Ken Kuljit Singh; Fiest, Kirsten M.; Codan, Cassidy; Shahid, Anmol; Fayed, Mohamed A.; Evans, Timothy M.; Garcia, Rebekah; Gutierrez, Ashley; Song, Tae H.; Rose, Rebecca; Bennett, Suzanne; Richardson, Denise; Peek, Giles J.; Arora, Lovkesh; Rappapport, Kristina; Rudolph, Kristina L.; Sibenaller, Zita; Stout, Lori; Walter, Alicia; Herr, Daniel L.; Vedadi, Nazli; Pesenti, Antonio; Thompson, Shaun L.; Sindt, Lace; Ewald, Cale; Hoffman, Julie; Ying, Xiaonan; Kennedy, Ryan; Griffee, Matthew J.; Ciullo, Anna L.; Kida, Yuri; Roca, Ricard Ferrer; Riera, Jordi I.; Contreras, Sofía; Alegre, Cynthia; Kay, Christy; Fischer, Irene; Renner, Elizabeth; Taniguci, Hayato; Suen, Jacky; Barnett, Adrian G.; Pearse, India; Abbate, Gabriella; Hassan, Halah; Heinsar, Silver; Karnik, Varun A.; Ki, Katrina K.; O’Neill, Hollier F.; Obonyo, Nchafatso G.; Pimenta, Leticia Pretti; Reid, Janice D.; Sato, Kei; Vuorinen, Aapeli; Wildi, Karin S.; Wood, Emily S.; Yerkovich, Stephanie Terase; Lee, James Tseryuan; Plotkin, Daniel R.; Citarella, Barbara Wanjiru; Hartley, Emma; Lubis, Bastian; Ikeyama, Takanari; Bhaskar, Balu; Jung, Jae-seung; McGuinness, Shay P.; Eastwood, Glenn Matthew; Marta, Sandra Rossi; Guarracino, Fabio; Gerle, Stacy; Coxon, Emily; Claro, Bruno; LoVerde, Daniel; Patil, Namrata T.; Parrini, Vieri; McBride, Angela; Negaard, Kathryn A.; Ratsch, Angela; Abdelaziz, Ahmed Yehia; Uribe, Juan David; Peris, Adriano; Sanders, Mark; Emerson, Dominic A.; Kamal, Muhammad; Póvoa, Pedro R.; Francis, Roland C.E.; Cherif, Ali; Joseph, Sunimol; Di Nardo, Matteo; Heard, Micheal L.; Kyle, Kimberly; Blackwell, Ray A.; Biston, Patrick; Jeong, Hye-won; Smith, Reanna; Prawira, Yogi; Montrucchio, G.; Garcia, Arturo Huerta; Salterain, Nahikari; Meyns, Bart P.; Moreno, Marsha; Walia, Rajat; Mehta, Amit; Schweda, Annette; Supriatna, Moh; Kirakli, Cenk; Williams, Melissa; Kim, Kyunghoon; Assad, Alexandra Rezende; Giraldo, Estefania; Karolak, Wojtek; Martin, Balik; Pocock, Elizabeth S.; Gajkowski, Evan F.; Masafumi, Kanamoto; Barrett, Nicholas A.; Takeyama, Yoshihiro; Park, Sunghoon; Amin, Faizan; Andriyani, Fina Meilyana; Sudakevych, Serhii M.; Vera, Magdalena M.; Vera, Magdalena; Schwarz, Patrícia De Souza; Mardini, Ana Carolina; de Paula, Thais; Neto, Ary Serpa; Villoldo, Andrea; Colafranceschi, Alexandre Siciliano; Úbeda-Iglesias, Alejandro; Granjean, Juan; Melro, Lívia Maria Garcia; Romualdo, Giovana Fioravante; Gaia, Diego Felipe; Souza, Helmgton; Galas, Filomena Regina Barbosa Gomes; Mendiluce, Rafael Mañez; Sosa, Alejandra; Martinez, Ignacio; Kurosawa, Hiroshi; Salgado, Juan; Hugi-MayrCharbonneau, Beate Eric; Barzilai, Vitor Salvatore; Monteiro, Verônica Soares; de Souza, Rodrigo Ribeiro; Harper, Michael D.; Suzuki, Hiroyuki; Adams, Celina; Brieva, Jorge L.; Nyale, George Mwamnemo; Eltatar, Faisal Saleem; Fatani, Jihan; Baeissa, Husam; Masri, Ayman Al; Rabie, Ahmed A.; Hui, Mokyee; Yamane, Masahiro; Jung, Hanna; Margaret, Ayorinde Mojisola; Nacpil, Newell R.; Ruck, Katja; Bakken, Rhonda M.; Jara, Claire; Felton, Tim W.; Berra, Lorenzo; Shah, Bobby; Chakraborty, Arpan; Cardona, Monika F.; Capatos, Gerry; Akkanti, Bindu H.; Orija, Abiodun Ayo; Jain, Harsh; Ito-Masui, Asami; Housni, Brahim; Low, Sennen; Iihara, Koji; Chavez, Joselito R.; Ramanathan, Kollengode R.; Zabert, Gustavo Enrique; Naidoo, Krubin; Seppelt, Ian M.; VanDyk, Marlice; MacDonald, Sarah; McGregor, Randy; Siebenaler, Teka; Flynn, Hannah; Lofton, Kristi; Aokage, Toshiyuki; Shigemitsu, Kazuaki; Moscatelli, Andrea; Fiorentino, Giuseppe; Baumgaertel, Matthias; Mba, Serge Eddy; Assy, Jana; Hutahaean, Amelya; Roush, Holly; Sichting, Kay A.; Alessandri, Francesco; Burns, Debra; Salt, Gavin; Garabedian, Carl P.; Millar, Jonathan E.; Sim, Malcolm A.B.; Mattke, Adrian Christian; McAuley, Daniel F.; Tadili, Jawad; Frenzel, Tim; Bar-Lavie, Yaron P.; Blandino-Ortiz, Aarón; Stone, Jackie; Attokaran, Antony George; Farquharson, Michael; Patel, Brij Y.; Gunning, Derek; Baillie, Kenneth J.; Watson, Pia; Tamai, Kenji; Sajinadiyasa, Gede Ketut; Sajinadiyasa, Gede Ketut; Salgado, Marcello; Sassine, Assad Miguel; Yudo, Bhirowo; McCaul, Scott; Lee, Bongjin; Lee, Sangmin; Afek, Arnon; Iwashita, Yoshiaki; Semedi, Bambang Pujo; Metiva, Jack; van Belle, Nicole; Martín-Loeches, Ignacio; Ivatt, Lenny; Woon, Chia Yew; Kang, Hyun Mi; Smith, Tim E.; James, Erskine A.; Al-Rawas, Nawar N.; Iwasaki, Yudai; King-Chung, Kenny Chan; Gudzenko, Vadim; Hugi-Mayr, Beate; Taccone, Fabio Silvio S.; Perdhana, Fajar; Lamarche, Yoan; Ribeiro, Joao Miguel; Bradić, Nikola; van den Bossche, Klaartje; Lansink, Oude; Singh, Gurmeet; Debeuckelaere, Gerdy; Stelfox, Thomas H.; Yi, Cassia; Elia, Jennifer M.; Tribble, Thomas Andrew; Shankar, Shyam; Padmanabhan, Raj; Hallinan, Bill; Paoletti, Luca; Leyva, Yolanda R.; Fykuda, Tatuma; Badulak, Jenelle H.; Koch, Jillian; Hackman, Amy; Janowaik, Lisa; Hernandez, Deb; Osofsky, Jennifer; Donadello, Katia; Lawang, Aizah; Fine, Josh; Davidson, Benjamin Paul; Razo, Oswaldo A.
DOI
10.1186/s13054-022-03983-5
발행일
2022
유형
Article
저널명
Critical Care
권
26
호
1