Use of Sedatives and Neuromuscular-Blocking Agents in Mechanically Ventilated Patients with COVID-19 ARDS

Objectives: To assess differences in the use of analgesics, sedatives and neuromuscular-blocking agents (NMBA) in patients with acute respiratory distress syndrome (ARDS) due to COVID-19 or other conditions. Methods: Retrospective observational cohort study, single-center tertiary Intensive Care Unit. COVID-19 patients with ARDS (March–May 2020) and non-COVID ARDS patients (2017–2020) on mechanical ventilation and receiving sedation for at least 48 h. Results: A total of 39 patients met the inclusion criteria in each group, with similar demographics at baseline. COVID-19 patients had a longer duration of MV (median 22 (IQRs 16–29) vs. 9 (6–18) days; p < 0.01), of sedatives administration (18 (11–22) vs. 5 (4–9) days; p < 0.01) and NMBA therapy (12 (9–16) vs. 3 (2–7) days; p < 0.01). During the first 7 days of sedation, compared to non-COVID patients, COVID patients received more frequently a combination of multiple sedative drugs (76.9% vs. 28.2%; p < 0.01) and a higher NMBA regimen (cisatracurium: 3.0 (2.1–3.7) vs. 1.3 (0.9–1.9) mg/kg/day; p < 0.01). Conclusions: The duration and consumption of sedatives and NMBA was significantly increased in patients with COVID-19 related ARDS than in non-COVID ARDS. Different sedation strategies and protocols might be needed in COVID-19 patients with ARDS, with potential implications on long-term complications and drugs availability.

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Treatment with Neuromuscular Blocking Agents and the Risk of In-hospital Mortality among Mechanically Ventilated Patients with Severe Sepsis

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2014.02.018 ◽

2014 ◽

Vol 46 (4) ◽

pp. 601

Author(s):

Cory Siebe

Keyword(s):

Severe Sepsis ◽

Hospital Mortality ◽

Neuromuscular Blocking ◽

Neuromuscular Blocking Agents ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Blocking Agents ◽

Ventilated Patients

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Neuromuscular blocking agents for ARDS: firm evidences for ICU mortality but for long-term mortality

Respiratory Care ◽

10.4187/respcare.08926 ◽

2021 ◽

pp. respcare.08926

Author(s):

Maria Vargas ◽

Giuseppe Servillo

Keyword(s):

Neuromuscular Blocking ◽

Neuromuscular Blocking Agents ◽

Icu Mortality ◽

Blocking Agents ◽

Long Term Mortality

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Neuromuscular blocking agents for acute respiratory distress syndrome

Journal of Critical Care ◽

10.1016/j.jcrc.2018.10.019 ◽

2019 ◽

Vol 49 ◽

pp. 179-184 ◽

Cited By ~ 7

Author(s):

Heather Torbic ◽

Abhijit Duggal

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Neuromuscular Blocking ◽

Neuromuscular Blocking Agents ◽

Blocking Agents

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Neuromuscular blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome*

Critical Care Medicine ◽

10.1097/01.ccm.0000239435.87433.0d ◽

2006 ◽

Vol 34 (11) ◽

pp. 2749-2757 ◽

Cited By ~ 202

Author(s):

Jean-Marie Forel ◽

Antoine Roch ◽

Valérie Marin ◽

Pierre Michelet ◽

Didier Demory ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Inflammatory Response ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Neuromuscular Blocking ◽

Neuromuscular Blocking Agents ◽

Blocking Agents

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A national survey of critical care nurses' practices related to administration of neuromuscular blocking agents

American Journal of Critical Care ◽

10.4037/ajcc2001.10.3.139 ◽

2001 ◽

Vol 10 (3) ◽

pp. 139-145 ◽

Cited By ~ 8

Author(s):

JG Foster ◽

SK Kish ◽

CH Keenan

Keyword(s):

Critical Care ◽

Peripheral Nerve ◽

The United States ◽

Neuromuscular Blocking ◽

Neuromuscular Blocking Agents ◽

Critical Care Nurses ◽

Blocking Agents ◽

Care Facilities ◽

Acute Care Facilities

BACKGROUND: Recommendations on use of neuromuscular blocking agents include using peripheral nerve stimulators to monitor depth of blockade and concomitantly administering sedatives and/or analgesics. OBJECTIVE: To evaluate critical care nurses' practices in administering neuromuscular blocking agents. METHODS: A 16-item survey was mailed to 483 acute care facilities in the United States. Of these, 246 surveys (51%) were returned and analyzed to determine use of neuromuscular blocking agents, peripheral nerve stimulators, sedatives, and analgesics. Logistic regression analysis was used to find independent predictors of use of peripheral nerve stimulators. RESULTS: Seventy-five percent of respondents reported long-term use of neuromuscular blocking agents in critically ill patients. Of those, 63% monitored the level of blockade with peripheral nerve stimulators. Reasons for not using peripheral nerve stimulators included unavailability of equipment (48%), lack of training (36%), and insufficient evidence that peripheral nerve stimulators improve care (23%). Predictors of use of stimulators were facilities with more than 150 beds (P < .001) and administration of neuromuscular blocking agents by continuous infusion (P < .001). Ninety-five percent of respondents reported using concurrent analgesics/sedatives always or most of the time. Facilities with fewer than 10 beds in the intensive care unit used concurrent analgesics/sedatives significantly less often than did facilities with 10 beds or more (90% vs 98%, respectively; P = .03). CONCLUSIONS: Small and large facilities differ in concomitant use of analgesics/sedatives and peripheral nerve stimulators. Education and research are needed to ensure that patients receive adequate monitoring and sedation during administration of neuromuscular blocking agents.

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