Physicians' attitudes and perceptions of neuromuscular blocker infusions in ARDS.
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 ANDMETHODS:
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.Keywords
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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