Sarah E Train, Karen E A Burns, Brian L Erstad, Anthony Massaro, Ting Ting Wu, John Vassaur, Kavitha Selvan, John P Kress, John W Devlin
Journal of critical care 2022 DecThe 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. 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). 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). 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. Copyright © 2022 Elsevier Inc. All rights reserved.
Sarah E Train, Karen E A Burns, Brian L Erstad, Anthony Massaro, Ting Ting Wu, John Vassaur, Kavitha Selvan, John P Kress, John W Devlin. Physicians' attitudes and perceptions of neuromuscular blocker infusions in ARDS. Journal of critical care. 2022 Dec;72:154165
PMID: 36209698
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