Farshid Rahimibashar; Mahmood Salesi; Amir Vahedian-Azimi; Masoum Khosh Fetrat
Abstract
Background: The study of neuromuscular blocking agents (NMBAs) in the management of acute respiratory distress syndrome (ARDS) has provided conflicting results in terms of their effect on mortality.Objectives: The main purpose of this study was to evaluate mortality in ARDS patients who underwent NMBA.Methods: ...
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Background: The study of neuromuscular blocking agents (NMBAs) in the management of acute respiratory distress syndrome (ARDS) has provided conflicting results in terms of their effect on mortality.Objectives: The main purpose of this study was to evaluate mortality in ARDS patients who underwent NMBA.Methods: A retrospective secondary analysis of 4200 patients with ARDS was collected from two academic medical centers, Tehran, Iran. This study was performed to assess the impact of NMBAs use in ARDS patients with different subgroups including mild and moderate-to-severe ARDS, age more and less than 65 years, having medical turnover vs. not-having, and high acute nursing care vs. moderate to low nursing care.Results: Intensive care unit (ICU) mortality has occurred in 1169 (27.8%) participants. The mortality rate was 28.6% and 27.5% in patients with mild and moderate-to-severe ARDS, respectively. In the subjects without medical turnover, the moderate dose of NMBAs significantly reduces the mortality of patients (P = 0.044). In patients who need high acute nursing care, increasing the NMBAs dose significantly reduces patients’ mortality (P = 0.010). In addition, increasing the NMBAs doses significantly reduces ICU length of stay (LOS).Conclusion: This study provides evidence that the administration of different doses of NMBAs had no effect on patients’ mortality with mild or moderate-to-severe ARDS. However, higher doses of NMBAs than low doses increased the risk of mortality in patients over 80 years and can reduce the risk of death in patients less than 55 years.
Bita Najafian; Bahareh Esmaeili; Mohammad Hossein Khosravi
Abstract
Background: Neonatal respiratory distress syndrome (NRDS), a life-threatening pulmonary disorder, involves 1% of all deliveries worldwide. Shallow breathing causes restlessness in infants, which itself affects pulmonary function; thus, sedative medications are used to preserve better pulmonary function. ...
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Background: Neonatal respiratory distress syndrome (NRDS), a life-threatening pulmonary disorder, involves 1% of all deliveries worldwide. Shallow breathing causes restlessness in infants, which itself affects pulmonary function; thus, sedative medications are used to preserve better pulmonary function. There are different opinions about the benefits and superiority of these drugs. Objective: The study purposed to assess and compare the effects of fentanyl and midazolam on the required time of mechanical ventilation in infants with respiratory distress syndrome (RDS). Methods: In this randomized clinical trial, 60 infants with RDS were randomly allocated to 2 groups (30 infants each); the first group underwent sedation with midazolam (0.1 mg/kg), and the second group received 0.5 mcg/kg of fentanyl during ventilation. The duration of hospitalization, required time of ventilation, drug complications, feeding intolerance, as well as pneumothorax incidence and need for re-intubation were recorded and compared between the 2 groups. Results: Eventually, 60 infants (45 male and 15 female) with a mean gestational age of 37.13±1.22 weeks in the midazolam group and 36.73±1.50 weeks in the fentanyl group underwent analysis (P value=0.449). Infants in the midazolam group had a mean length of stay of 11.96 ± 3.41 days, while mean length of stay was 10.36±3.57 days for infants in the fentanyl group (P value=0.039). Mean duration of mechanical ventilation was 4.6±2.14 days in the midazolam group and 4.06±2.04 days in the fentanyl group (P value=0.252). Conclusion: The findings suggest that midazolam is a more suitable medication for the sedation of infants under mechanical ventilation in comparison with fentanyl; however, its side effects, such as apnea, pneumonia, and seizure, should be considered.