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Physicians' attitudes and perceptions of neuromuscular blocker infusions in ARDS.
Train, Sarah E; Burns, Karen E A; Erstad, Brian L; Massaro, Anthony; Wu, Ting Ting; Vassaur, John; Selvan, Kavitha; Kress, John P; Devlin, John W.
  • Train SE; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, United States of America.
  • Burns KEA; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
  • Erstad BL; College of Pharmacy, University of Arizona, Tucson, AZ, United States of America.
  • Massaro A; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, United States of America.
  • Wu TT; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, United States of America; Bouve College of Health Sciences, Northeastern University, Boston, MA, United States of America.
  • Vassaur J; Division of Pulmonary and Critical Care Medicine, University of Arizona Medical Center, Tucson, AZ, United States of America.
  • Selvan K; Division of Pulmonary, Critical Care and Sleep Medicine, University of Chicago Medical Center, Chicago, IL, United States of America.
  • Kress JP; Division of Pulmonary, Critical Care and Sleep Medicine, University of Chicago Medical Center, Chicago, IL, United States of America.
  • Devlin JW; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, United States of America; Bouve College of Health Sciences, Northeastern University, Boston, MA, United States of America. Electronic address: jwdevlin@bwh.harvard.edu.
J Crit Care ; 72: 154165, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2061478
ABSTRACT

PURPOSE:

The perceptions and practices of ICU physicians regarding initiating neuromuscular blocker infusions (NMBI) in acute respiratory distress syndrome (ARDS) may not be evidence-based amidst the surge of severe ARDS during the SARS-CoV-2 pandemic and new practice guidelines. We identified ICU physicians' perspectives and practices regarding NMBI use in adults with moderate-severe ARDS. MATERIALS AND

METHODS:

After extensive development and testing, an electronic survey was distributed to 342 ICU physicians from three geographically-diverse U.S. health systems(n = 12 hospitals).

RESULTS:

The 173/342 (50.5%) respondents (75% medical) somewhat/strongly agreed a NMBI should be reserved until after a trial of deep sedation (142, 82%) or proning (59, 34%) and be dose-titrated based on train-of-four monitoring (107, 62%). Of 14 potential NMBI risks, 2 were frequently reported to be of high/very high concern prolonged muscle weakness with steroid use (135, 79%) and paralysis awareness due to inadequate sedation (114, 67%). Absence of dyssychrony (93, 56%) and use ≥48 h (87, 53%) were preferred NMBI stopping criteria. COVID-19 + ARDS patients were twice as likely to receive a NMBI (56 ± 37 vs. 28 ± 19%, p < 0.01).

CONCLUSIONS:

Most intensivists agreed NMBI in ARDS should be reserved until after a deep sedation trial. Stopping criteria remain poorly defined. Unique considerations exist regarding the role of paralysis in COVID-19+ ARDS.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Physicians / Respiratory Distress Syndrome / COVID-19 / Neuromuscular Blocking Agents Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Humans Language: English Journal: J Crit Care Journal subject: Critical Care Year: 2022 Document Type: Article Affiliation country: J.jcrc.2022.154165

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Physicians / Respiratory Distress Syndrome / COVID-19 / Neuromuscular Blocking Agents Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Humans Language: English Journal: J Crit Care Journal subject: Critical Care Year: 2022 Document Type: Article Affiliation country: J.jcrc.2022.154165