학술논문
Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis
adult respiratory distress syndrome
adult respiratory distress syndrome
Document Type
Report
Author
Li Bassi, Gianluigi; Gibbons, Kristen; Suen, Jacky Y.; Dalton, Heidi J.; White, Nicole; Corley, Amanda; Shrapnel, Sally; Hinton, Samuel; Forsyth, Simon; Laffey, John G.; Fan, Eddy; Fanning, Jonathon P.; Panigada, Mauro; Bartlett, Robert; Brodie, Daniel; Burrell, Aidan; Chiumello, Davide; Elhazmi, Alyaa; Esperatti, Mariano; Grasselli, Giacomo; Hodgson, Carol; Ichiba, Shingo; Luna, Carlos; Marwali, Eva; Merson, Laura; Murthy, Srinivas; Nichol, Alistair; Ogino, Mark; Pelosi, Paolo; Torres, Antoni; Ng, Pauline Yeung; Fraser, John F.; Al-Dabbous, Tala; Alfoudri, Huda; Shamsah, Mohammed; Elapavaluru, Subbarao; Berg, Ashley; Horn, Christina; Mayasi, Yunis; Schroll, Stephan; Meyer, Dan; Velazco, Jorge; Ploskanych, Ludmyla; Fikes, Wanda; Bagewadi, Rohini; Dao, Marvin; White, Haley; Ehlers, Ashley; Shalabi-McGuire, Maysoon; Witt, Trent; Grazioli, Lorenzo; Lorini, Luca; Grandin, E. Wilson; Nunez, Jose; Reyes, Tiago; OBriain, Diarmuid; Hunter, Stephanie; Ramanan, Mahesh; Affleck, Julia; Veerendra, Hemanth Hurkadli; Rai, Sumeet; Russell-Brown, Josie; Nourse, Mary; Joseph, Mark; Mitchell, Brook; Tenzer, Martha; Abe, Ryuzo; Cho, Hwa Jin; Jeong, In Seok; Rahman, Nadeem; Kakar, Vivek; Brozzi, Nicolas; Mehkri, Omar; Krishnan, Sudhir; Duggal, Abhijit; Houltham, Stuart; Graf, Jerónimo; Diaz, Roderigo; Orrego, Roderigo; Delgado, Camila; González, Joyce; Sanchez, Maria Soledad; Piagnerelli, Michael; Sarrazin, Josefa Valenzuela; Zabert, A./Prof. Gustavo; Espinosa, Lucio; Delgado, Paulo; Delgado, Victoria; Rincón, Diego Fernando Bautista; Yanten, Angela Maria Marulanda; Duque, Melissa Bustamante; Al-Hudaib, Abdullah; Callahan, Maria; Taufik, M. Azhari; Wardoyo, Elizabeth Yasmin; Gunawan, Margaretha; Trisnaningrum, Nurindah S.; Irawany, Vera; Rayhan, Muhammad; Pesenti, Antonia; Zanella, Alberto; Leone, Michela; Coppola, Silvia; Colombo, Sebastiano; Antonelli, Massimo; Carelli, Simone; Grieco, Domenico L.; Asaki, Motohiro; Hoshino, Kota; Salazar, Leonardo; Duarte, Laura; Laffey, John; McNicholas, Bairbre; Cosgrave, David; McCaffrey, Joseph; Bone, Allison; Hakeem, Yusuff; Winearls, James; Tallott, Mandy; Thomson, David; Arnold-Day, Christel; Cupido, Jerome; Fanie, Zainap; Miller, Malcom; Seymore, Lisa; van Straaten, Dawid; Hssain, Ali Ait; Aliudin, Jeffrey; Alqahtani, Al-Reem; Mohamed, Khoulod; Mohamed, Ahmed; Tan, Darwin; Villanueva, Joy; Zaqout, Ahmed; Kurtzman, Ethan; Ademi, Arben; Dobrita, Ana; El Aoudi, Khadija; Segura, Juliet; Giwangkancana, Gezy; Ohshimo, Shinichiro; Hoshino, Koji; Hitoshi, Saito; Osatnik, Javier; Joosten, Anne; Yang, Minlan; Motos, Ana; Arancibia, Francisco; Williams, Virginie; Noel, Alexandre; Luque, Nestor; Trung, Trieu Huynh; Yacoub, Sophie; Fantini, Marina; García, Ruth Noemi Jorge; Alvarez, Enrique Chicote; Greti, Anna; Ceccato, Adrian; Sanchez, Angel; Vazquez, Ana Loza; Roche-Campo, Ferran; Franch-Llasat, Diego; Tuazon, Divina; Amato, Marcelo; Cassimiro, Luciana; Pola, Flavio; Ribeiro, Francis; Fonseca, Guilherme; Dalton, Heidi; Desai, Mehul; Osborn, Erik; Deeb, Hala; Arcadipane, Antonio; Martucci, Gennaro; Panarello, Giovanna; Vitiello, Chiara; Bianco, Claudia; Occhipinti, Giovanna; Rossetti, Matteo; Cuffaro, Raffaele; Cho, Sung-Min; Shimizu, Hiroaki; Moriyama, Naoki; Kim, Jae-Burm; Kitamura, Nobuya; Gebauer, Johannes; Yokoyama, Toshiki; Al-Fares, Abdulrahman; Buabbas, Sarah; Alamad, Esam; Alawadhi, Fatma; Alawadi, Kalthoum; Tanaka, Hiro; Hashimoto, Satoru; Yamazaki, Masaki; Oh, Tak-Hyuck; Epler, Mark; Forney, Cathleen; Kruse, Louise; Feister, Jared; Williamson, Joelle; Grobengieser, Katherine; Gnall, Eric; Golden, Sasha; Caroline, Mara; Shapiro, Timothy; Karaj, Colleen; Thome, Lisa; Sher, Lynn; Vanderland, Mark; Welch, Mary; McDermott, Sherry; Brain, Matthew; Mineall, Sarah; Kimura, Dai; Brazzi, Luca; Sales, Gabriele; Ogston, Tawnya; Nagpal, Dave; Fischer, Karlee; Lorusso, Roberto; Rangappa, Rajavardhan; Rai, Sujin; Appu, Argin; Carton, Edmund G.; Sen, Ayan; Palacios, Amanda; Rainey, Deborah; Samoukoviv, Gordan; Campisi, Josie; Durham, Lucia; Neumann, Emily; Seefeldt, Cassandra; Falcucci, Octavio; Emmrich, Amanda; Guy, Jennifer; Johns, Carling; Potzner, Kelly; Zimmermann, Catherine; Espinal, Angelia; Buchtele, Nina; Schwameis, Michael; Stecher, Stephanie-Susanne; Singh, Delila; Barnikel, Michaela; Arenz, Lukas; Zaaqoq, Akram; Galloway, Lan Anh; Merley, Caitlin; Csete, Marc; Quesada, Luisa; Saba, Isabela; Kasugai, Daisuke; Hiraiwa, Hiroaki; Tanaka, Taku; Purnama, Yoel; Dewayanti, Santi Rahayu; Juzar, Dafsah Arifa; Siagian, Debby; Chen, Yih-Sharng; Ratsep, Indrek; Oigus, Getter; Erikson, Kristo; Post, Andra-Maris; Enneveer, Lauri; Sillaots, Piret; Manetta, Frank; Mihelis, Effe; Sarmiento, Iam Claire; Narasimhan, Mangala; Varrone, Michael; Komats, Mamoru; Garcia-Diaz, Julia; Harmon, Catherine; Satyapriya, S. Veena; Bhatt, Amar; Mokadam, Nahush A.; Uribe, Alberto; Gonzalez, Alicia; Shi, Haixia; McKeown, Johnny; Pasek, Joshua; Fiorda, Juan; Echeverria, Marco; Moreno, Rita; Zakhary, Bishoy; Cavana, Marco; Cucino, Alberto; Foti, Giuseppe; Giani, Marco; Russotto, Vincenzo; Castagna, Valentina; DellAmore, Andrea; Navalesi, Paolo; Shum, Hoi-Ping; Vuysteke, Alain; Usman, Asad; Acker, Andrew; Smood, Benjamin; Mergler, Blake; Sertic, Federico; Subramanian, Madhu; Sperry, Alexandra; Rizer, Nicolas; Burhan, Erlina; Rasmin, Menaldi; Akmal, Ernita; Sitompul, Faya; Lolong, Navy; Naivedh, Bhat; Erickson, Simon; Barrett, Peter; Dean, David; Daugherty, Julia; Loforte, Antonio; Khan, Irfan; Abraar Quraishi, Mohammed; DeSantis, Olivia; So, Dominic; Kandamby, Darshana; Mandei, Jose M.; Natanael, Hans; YudhaLantang, Eka; Lantang, Anastasia; Wijaya, Surya Oto; Jung, Anna; Ng, George; Ng, Wing Yiu; Fang, Shu; Tabah, Alexis; Ratcliffe, Megan; Duroux, Maree; Adachi, Shingo; Nakao, Shota; Blanco, Pablo; Prieto, Ana; Sánchez, Jesús; Nicholson, Meghan; Butt, Warwick; Serratore, Alyssa; Delzoppo, Carmel; Janin, Pierre; Yarad, Elizabeth; Totaro, Richard; Coles, Jennifer; Pujo, Bambang; Balk, Robert; Vissing, Andy; Kapania, Esha; Hays, James; Fox, Samuel; Yantosh, Garrett; Mishin, Pavel; Yuliarto, Saptadi; Hari Santoso, Kohar; Djajalaksana, Susanthy; Fatoni, Arie Zainul; Fukuda, Masahiro; Liu, Keibun; Battaglini, Denise; Jiménez, Juan Fernando Masa; Bastos, Diego; Gaião, Sérgio; Rusmawatiningtyas, Desy; Buchner, Jessica; Cho, Young-Jae; Lee, Su Hwan; Kawasaki, Tatsuya; Munshi, Laveena; Sakiyalak, Pranya; Nitayavardhana, Prompak; Seitz, Tamara; Arora, Rakesh; Kent, David; Marino, Daniel; Parwar, Swapnil; Cheng, Andrew; Miller, Jennene; Fujitani, Shigeki; Shimizu, Naoki; Madhok, Jai; Owyang, Clark; Buscher, Hergen; Reynolds, Claire; Maasikas, Olavi; Beljantsev, Aleksan; Mihnovits, Vladislav; Akimoto, Takako; Aizawa, Mariko; Horibe, Kanako; Onodera, Ryota; Young, Meredith; George, Timothy; Shekar, Kiran; McGuinness, Niki; Irvine, Lacey; Flynn, Brigid; Endo, Tomoyuki; Sugiyama, Kazuhiro; Shimizu, Keiki; Exconde, Kathleen; Lussier, Leslie; Lotz, Gösta; Malfertheiner, Maximilian; Maier, Lars; Dreier, Esther; Kusumastuti, Neurinda Permata; McCloskey, Colin; Dabaliz, Al-Awwab; Elshazly, Tarek B.; Smith, Josiah; Szuldrzynski, Konstanty S.; BielaÅski, Piotr; Wille, Keith; Parhar, Ken Kuljit S.; Fiest, Kirsten M.; Codan, Cassidy; Shahid, Anmol; Fayed, Mohamed; Evans, Timothy; Garcia, Rebekah; Gutierrez, Ashley; Song, Tae; Rose, Rebecca; Bennett, Suzanne; Richardson, Denise; Peek, Giles; Arora, Lovkesh; Rappapport, Kristina; Rudolph, Kristina; Sibenaller, Zita; Stout, Lori; Walter, Alicia; Herr, Daniel; Vedadi, Nazli; Pesenti, Antonio; Thompson, Shaun; Sindt, Lace; Rajnic, Sean; Ewald, Cale; Hoffman, Julie; Ying, Xiaonan; Kennedy, Ryan; Griffee, Matthew; Ciullo, Anna; Kida, Yuri; Roca, Ricard Ferrer; Riera, JordI; Contreras, Sofia; Alegre, Cynthia; Kay, Christy; Fischer, Irene; Renner, Elizabeth; Taniguci, Hayato; Fraser, John; Bassi, Gianluigi Li; Suen, Jacky; Barnett, Adrian; Pearse, India; Abbate, Gabriella; Hassan, Halah; Heinsar, Silver; Karnik, Varun A.; Ki, Katrina; ONeill, Hollier F.; Obonyo, Nchafatso; Pimenta, Leticia Pretti; Reid, Janice D.; Sato, Kei; Vuorinen, Aapeli; Wildi, Karin S.; Wood, Emily S.; Yerkovich, Stephanie; Lee, James; Plotkin, Daniel; Citarella, Barbara Wanjiru; Hartley, Emma; Lubis, Bastian; Ikeyama, Takanari; Bhaskar, Balu; Jung, Jae-Seung; McGuinness, Shay; Eastwood, Glenn; Marta, Sandra Rossi; Guarracino, Fabio; Gerle, Stacy; Coxon, Emily; Claro, Bruno; Loverde, Daniel; Patil, Namrata; Parrini, Vieri; McBride, Angela; Negaard, Kathryn; Ratsch, Angela; Abdelaziz, Ahmad; Uribe, Juan David; Peris, Adriano; Sanders, Mark; Emerson, Dominic; Kamal, Muhammad; Povoa, Pedro; Francis, Roland; Cherif, Ali; Joseph, Sunimol; Di Nardo, Matteo; Heard, Micheal; Kyle, Kimberly; Blackwell, Ray A.; Biston, Patrick; Jeong, Hye Won; Smith, Reanna; Prawira, Yogi; Montrucchio, Giorgia; Garcia, Arturo Huerta; Salterain, Nahikari; Meyns, Bart; Moreno, Marsha; Walia, Rajat; Mehta, Amit; Schweda, Annette; Supriatna, Moh; Kirakli, Cenk; Williams, Melissa; Kim, Kyung Hoon; Assad, Alexandra; Giraldo, Estefania; Karolak, Wojtek; Balik, Martin; Pocock, Elizabeth; Gajkowski, Evan; Masafumi, Kanamoto; Barrett, Nicholas; Takeyama, Yoshihiro; Park, Sunghoon; Amin, Faizan; Andriyani, Fina Meilyana; Sudakevych, Serhii; Vera, Magdalena; Cornejo, Rodrigo; Schwarz, Patrícia; Mardini, Ana Carolina; de Paula, Thais; Neto, Ary Serpa; Villoldo, Andrea; Colafranceschi, Alexandre Siciliano; Iglesias, Alejandro Ubeda; Granjean, Juan; Melro, Lívia Maria Garcia; Romualdo, Giovana Fioravante; Gaia, Diego; Souza, Helmgton; Galas, Filomena; Mendiluce, Rafael Máéez; Sosa, Alejandra; Martinez, Ignacio; Kurosawa, Hiroshi; Salgado, Juan; Hugi-MayrCharbonneau, Beate Eric; Barzilai, Vitor Salvatore; Monteiro, Veronica; de Souza, Rodrigo Ribeiro; Harper, Michael; Suzuki, Hiroyuki; Adams, Celina; Brieva, Jorge; Nyale, George; Eltatar, Faisal Saleem; Fatani, Jihan; Baeissa, Husam; Masri, Ayman AL; Rabie, Ahmed; Hui, Mok Yee; Yamane, Masahiro; Jung, Hanna; Margaret, Ayorinde Mojisola; Nacpil, Newell; Ruck, Katja; Bakken, Rhonda; Jara, Claire; Felton, Tim; Berra, Lorenzo; Shah, Bobby; Chakraborty, Arpan; Cardona, Monika; Capatos, Gerry; Akkanti, Bindu; Orija, Abiodun; Jain, Harsh; Ito, Asami; Housni, Brahim; Low, Sennen; Iihara, Koji; Chavez, Joselito; Ramanathan, Kollengode; Zabert, Gustavo; Naidoo, Krubin; Seppelt, Ian; VanDyk, Marlice; MacDonald, Sarah; McGregor, Randy; Siebenaler, Teka; Flynn, Hannah; Lofton, Kristi; Aokage, Toshiyuki; Shigemitsu, Kazuaki; Moscatelli, Andrea; Fiorentino, Giuseppe; Baumgaertel, Matthias; Mba, Serge Eddy; Assy, Jana; Hutahaean, Amelya; Roush, Holly; Sichting, Kay A.; Alessandri, Francesco; Burns, Debra; Salt, Gavin; Garabedian, Carl P.; Millar, Jonathan; Sim, Malcolm; Mattke, Adrian; McAuley, Danny; Tadili, Jawad; Frenzel, Tim; Bar-Lavie, Yaron; Ortiz, Aaron Blandino; Stone, Jackie; Attokaran, Antony; Farquharson, Michael; Patel, Brij; Gunning, Derek; Baillie, Kenneth; Watson, Pia; Tamai, Kenji; Sajinadiyasa, Gede Ketut; Kanyawati, Dyah; Salgado, Marcello; Sassine, Assad; Yudo, Bhirowo; McCaul, Scott; Lee, Bongjin; Lee, Sang Min; Afek, Arnon; Iwashita, Yoshiaki; Semedi, Bambang Pujo; Metiva, Jack; Van Belle, Nicole; Martin-Loeches, Ignacio; Ivatt, Lenny; Woon, Chia Yew; Kang, Hyun Mi; Smith, Timothy; James, Erskine; Al-Rawas, Nawar; Iwasaki, Yudai; King-Chung, Kenny Chan; Gudzenko, Vadim; Hugi-Mayr, Beate; Taccone, Fabio; Perdhana, Fajar; Lamarche, Yoan; Ribeiro, Joao Miguel; Bradic, Nikola; Van den Bossche, Klaartje; Lansink, Oude; Singh, Gurmeet; Debeuckelaere, Gerdy; Stelfox, Henry T.; Yi, Cassia; Elia, Jennifer; Tribble, Thomas; Shankar, Shyam; Padmanabhan, Raj; Hallinan, Bill; Paoletti, Luca; Leyva, Yolanda; Fykuda, Tatuma; Badulak, Jenelle; Koch, Jillian; Hackman, Amy; Janowaik, Lisa; Hernandez, Deb; Osofsky, Jennifer; Donadello, Katia; Lawang, Aizah; Fine, Josh; Davidson, Benjamin; Vazquez, Andres Oswaldo Razo
Source
Critical Care. May 17, 2022, Vol. 26 Issue 1
Subject
Language
English
ISSN
1364-8535
Abstract
Author(s): Gianluigi Li Bassi[sup.1,2,3,4,5,6] , Kristen Gibbons[sup.7] , Jacky Y. Suen[sup.1,2] , Heidi J. Dalton[sup.8] , Nicole White[sup.4] , Amanda Corley[sup.1,2] , Sally Shrapnel[sup.2,9] , Samuel Hinton[sup.2] , Simon Forsyth[sup.2] [...]
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 ([+ or -] SD) age was 60.3 [+ or -] 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. Keywords: SARS-CoV-2, COVID-19, Neuromuscular blocking agent, Mechanical ventilation, Intensive care unit
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 ([+ or -] SD) age was 60.3 [+ or -] 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. Keywords: SARS-CoV-2, COVID-19, Neuromuscular blocking agent, Mechanical ventilation, Intensive care unit