Respiratory failure & ventilation
Neuromuscular blockade and their monitoring in the intensive care unit: a multicenter observational prospective study
Authors' conclusion
In our study, the prevalence of continuous neuromuscular blocking agents infusion among mechanically ventilated patients in the intensive care unit was 10.3%. While acute respiratory distress syndrome was the main indication, over one-third of patients received neuromuscular blocking agents for other reasons. A duration of neuromuscular blocking agents infusion exceeding 48 hours was associated with longer mechanical ventilation and increased complications.
Study context
- Population
- Adults on invasive mechanical ventilation receiving continuous NMBA infusion in 19 ICUs in France and Belgium232 continuous infusion
- Participants
- 2,248 adults
- Outcome
- Use of NMBAs in a real-world setting (prevalence of continuous NMBA infusion among mechanically ventilated patients)
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
- Continuous NMBA infusion
- 232 (10.3%)
- At least one dose of NMBA
- 270 (12%)
- Indication: ARDS
- 61%
- Indication: prevention of shivering during therapeutic hypothermia
- 16%
- Indication: patient-ventilator asynchrony
- 12%
- Infusion start after ICU admission, median [range] days
- 0 [0-2]
- Infusion duration, median hours
- 38 [22-71]
- Cisatracurium as agent
- 74%
- NMBA monitoring by TOF
- 48%
Observational data: associations, not effects.
Further findings
ICU mortality, by NMBA monitoring (multivariable analysis)
| HR (95% CI) | P value | ||
|---|---|---|---|
| Neuromuscular blocking agents monitoringReduced ICU mortality | 0.55 (0.32–0.95) | P = 0.032 | |
| 0.20.5125Hazard ratio (log scale) |
Main indications for NMBA use
- ARDS
- 61%
- Prevention of shivering during therapeutic hypothermia
- 16%
- Patient-ventilator asynchrony
- 12%
Infusion timing, duration, agent and TOF monitoring
- Days from ICU admission to infusion start, median [IQR]
- 0 [0-2]
- Infusion duration, median [IQR], hours
- 38 [22-71]
- Cisatracurium as preferred agent
- 74%
- NMBA monitoring by TOF
- 48%
Duration of mechanical ventilation, ICU LOS and ICU mortality
- Mechanical ventilation, median [IQR], days
- 9 [4-16]
- ICU LOS, median [IQR], days
- 13 [6-22]
- ICU mortality
- 41%
Safety
ICU-acquired weakness, by NMBA monitoring (multivariable analysis)
| OR (CI) | P value | ||
|---|---|---|---|
| Neuromuscular blocking agents monitoringIncreased ICU-acquired weakness | 2.90 (1.2–7.01) | P = 0.018 | |
| 0.10.31310Odds ratio (log scale) |
Complications
- ICU-acquired weakness
- 25%
- Pressure ulcers
- 14%
- VAP
- 26%
VAP, by NMBA infusion duration (multivariable analysis)
- NMBA infusion exceeding 48 hours associated with higher incidences of VAP
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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