Respiratory failure & ventilation
The impact of aggressive and conservative propensity for initiation of neuromuscular blockade in mechanically ventilated patients with hypoxemic respiratory failure
Authors' conclusion
Aggressive or conservative initiation of NMB may worsen mortality.
Study context
- Population
- Ventilated patients with PaO2/FiO2 ratio < 150 mmHg and PEEP≥ 8cmH2O, MIMIC-IV database13.3% initiated on neuromuscular blockade (NMB)
- Participants
- 5,221 patients
- Exposure
- Aggressive (5-fold higher) or conservative (5-fold lower) hourly propensity for NMB initiation vs usual care
- Outcome
- In-hospital mortality and ventilator-free days
Methodological detailsincremental interventions, inverse probability weighting
- Incremental interventions
- Inverse probability weighting
Main finding
As reported in the abstract
In-hospital mortality
Each group vs usual careIncrease in in-hospital mortality (0.95 CI)
Aggressive
2.6%([1.5%,3.7%])
Conservative
1.3%([0.1%,2.5%])
Observational data: associations, not effects.
Further findings
| Outcome | Aggressive | Conservative |
|---|---|---|
| NMB usage | 36.5% (CI [34.3%,38.7%]) | 3.8% (CI [3.3%,4.3%]) |
Healthier patient cohort (secondary analysis)
- Results similar; conservative strategies also improved ventilator-free days
Original publication
The impact of aggressive and conservative propensity for initiation of neuromuscular blockade in mechanically ventilated patients with hypoxemic respiratory failure. J Crit Care. Published 28 March 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →