Neuromuscular Blocking Agent Use in Acute Respiratory Distress Syndrome: Which Variable is Important?

Rahimibashar, Farshid; Salesi, Mahmood; Vahedian-Azimi, Amir; Khosh Fetrat, Masoum

doi:10.34172/hpr.2021.22

Neuromuscular Blocking Agent Use in Acute Respiratory Distress Syndrome: Which Variable is Important?

Document Type : Original Article

Authors

Farshid Rahimibashar ¹

Mahmood Salesi ²

Amir Vahedian-Azimi ³

Masoum Khosh Fetrat ⁴

¹ Department of Anesthesiology and Critical Care, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

² Chemical Injuries Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran

³ Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran

⁴ Department of Anesthesiology and Critical Care, Khatamolanbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran

10.34172/hpr.2021.22

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: 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.

Keywords

Respiratory Distress Syndrome

Acute

Neuromuscular Blocking Agents

Mortality