TY - JOUR
T1 - Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS
T2 - a propensity score analysis
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 - Ehlers, Ashley
AU - Shalabi-McGuire, Maysoon
AU - COVID-19 Critical Care Consortium
AU - Lorusso, Roberto
N1 - Funding Information:
We recognize the crucial importance of the ISARIC and SPRINT-SARI networks in developing and expanding the global COVID-19 Critical Care Consortium. We thank the generous support we received from the Extracorporeal Life Support Organization (ELSO) and the International ECMO Network (ECMONet). We greatly acknowledge Adrian Barnett for his invaluable contribution to the analysis plan and statistical insights. We greatly acknowledge Gabriele Fior (University of Milan) for his input and contribution to the critical revision of the manuscript. We owe Li Wenliang, MD, from the Wuhan Central Hospital, an eternal debt of gratitude for reminding the world that doctors should never be censored during a pandemic. Finally, we acknowledge all members of the COVID-19 Critical Care Consortium and various collaborators as reported in the Additional file 1 : Appendix.
Funding Information:
A/Prof Li Bassi received research support from Fisher & Paykel outside the submitted work. Prof. Dalton consults with Innovative ECMO Concepts, Abiomed and Instrumentation Labs, which does not affect the current work. Prof. Brodie receives research support from ALung Technologies, and he has been on the medical advisory boards for Baxter, Abiomed, Xenios, and Hemovent. A/Prof Fan reports personal fees from ALung Technologies, Baxter, Fresenius Medical Care, Getinge, and MC3 Cardiopulmonary outside the submitted work. Prof. Laffey reports consulting fees from Baxter and Cala Medical, both outside the submitted work. Prof. Nichol is supported by a Health Research Board of Ireland Award (CTN-2014-012). Prof. Fraser receives research support from Fisher & Paykel outside the submitted work. Prof. Grasselli reports personal fees from Draeger Medical, Biotest, Getinge, Fisher & Paykel, and MSD outside the submitted work.
Funding Information:
The University of Queensland; The Wesley Medical Research; The Prince Charles Hospital Foundation; Bill & Melinda Gates Foundation c/o Open Access—Grant number INV-034765; The Health Research Board of Ireland; Gianluigi Li Bassi is a recipient of the BITRECS fellowship; the BITRECS” project has received funding from the European Unions Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement no. 754550 and from the La Caixa” Foundation (ID 100010434), under the agreement LCF/PR/GN18/50310006. Finally, Carol Hodgson is funded by the National Health and Medical Research Council Grant.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/5/17
Y1 - 2022/5/17
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
U2 - 10.1186/s13054-022-03983-5
DO - 10.1186/s13054-022-03983-5
M3 - Article
SN - 1364-8535
VL - 26
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 141
ER -