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

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 ۴۲۰۰ 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 ۶۵ 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 ۱۱۶۹ (۲۷.۸%) participants. The mortality rate was ۲۸.۶% and ۲۷.۵% 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 = ۰.۰۴۴). In patients who need high acute nursing care, increasing the NMBAs dose significantly reduces patients’ mortality (P = ۰.۰۱۰). 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 ۸۰ years and can reduce the risk of death in patients less than ۵۵ years.

Keywords:

Respiratory Distress Syndrome , Acute , Neuromuscular Blocking Agents , mortality