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Critical Care Pharmacist Attitudes and Perceptions of Neuromuscular Blocker Infusions in ARDS.
Devlin, John W; Train, Sarah E; Burns, Karen E A; Massaro, Anthony; Wu, Ting Ting; Castor, Timothy; Vassaur, John; Selvan, Kavitha; Kress, John P; Erstad, Brian L.
  • Devlin JW; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.
  • Train SE; Bouve College of Health Sciences, Northeastern University, Boston, MA, USA.
  • Burns KEA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.
  • Massaro A; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
  • Wu TT; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Castor T; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
  • Vassaur J; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.
  • Selvan K; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.
  • Kress JP; Bouve College of Health Sciences, Northeastern University, Boston, MA, USA.
  • Erstad BL; Bouve College of Health Sciences, Northeastern University, Boston, MA, USA.
Ann Pharmacother ; : 10600280231160437, 2023 Mar 22.
Article in English | MEDLINE | ID: covidwho-2257008
ABSTRACT

BACKGROUND:

Current critical care pharmacist (CCP) practices and perceptions related to neuromuscular infusion (NMBI) use for acute respiratory distress syndrome (ARDS) maybe different with the COVID-19 pandemic and the publication of 2020 NMBI practice guidelines.

OBJECTIVE:

To evaluate CCP practices and perceptions regarding NMBI use for patients with moderate-severe ARDS.

METHODS:

We developed, tested, and electronically administered a questionnaire (7 parent-, 42 sub-questions) to 409 American College of Clinical Pharmacy (ACCP) Critical Care Practice and Research Network members in 12 geographically diverse states. The questionnaire focused on adults with moderate-severe ARDS (PaO2FiO2<150) whose causes of dyssynchrony were addressed. Two reminders were sent at 10-day intervals.

RESULTS:

Respondents [131/409 (32%)] primarily worked in a medical intensive care unit (ICU) 102 (78%). Compared to COVID-negative(-) ARDS patients, COVID positive(+) ARDS patients were twice as likely to receive a NMBI (34 ± 18 vs.16 ± 17%; P < 0.01). Respondents somewhat/strongly agreed a NMBI should be reserved until after trials of deep sedation (112, 86%) or proning (92, 81%) and that NMBI reduced barotrauma (88, 67%), dyssynchrony (87, 66%), and plateau pressure (79, 60%). Few respondents somewhat/strongly agreed that a NMBI should be initiated at ARDS onset (23, 18%) or that NMBI reduced 90-day mortality (12, 10%). Only 2/14 potential NMBI risks [paralysis awareness (101, 82%) and prolonged muscle weakness (84, 68%)] were frequently reported to be of high/very high concern. Multiple NMBI titration targets were assessed as very/extremely important including arterial pH (109, 88%), dyssynchrony (107, 86%), and PaO2 FiO2 ratio (82, 66%). Train-of-four (55, 44%) and BIS monitoring (36, 29%) were deemed less important. Preferred NMBI discontinuation criteria included absence of dysschrony (84, 69%) and use ≥48 hour (72, 59%). CONCLUSIONS AND RELEVANCE Current critical care pharmacists believe NMBI for ARDS patients are best reserved until after trials of deep sedation or proning; unique considerations exist in COVID+ patients. Our results should be considered when ICU NMBI protocols are being developed and bedside decisions regarding NMBI use in ARDS are being formulated.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study Language: English Journal: Ann Pharmacother Journal subject: Pharmacology / Drug Therapy Year: 2023 Document Type: Article Affiliation country: 10600280231160437

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study Language: English Journal: Ann Pharmacother Journal subject: Pharmacology / Drug Therapy Year: 2023 Document Type: Article Affiliation country: 10600280231160437