Neuromuscular blockade in mechanically ventilated pneumonia patients with moderate to severe hypoxemia: A multicenter retrospective study

The benefit of neuromuscular blockades (NMBs) in critically ill patients receiving mechanical ventilation remains uncertain. Therefore, we aimed to investigate whether NMB use is associated with improved survival of mechanically ventilated pneumonia patients with moderate to severe hypoxemia. This r...

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Bibliographic Details
Published in:PloS one 2022-12, Vol.17 (12), p.e0277503-e0277503
Main Authors: Baek, Moon Seong, Kim, Jong Ho, Lim, Yaeji, Kwon, Young Suk
Format: Article
Language:English
Subjects:
Age
Anesthesia
Anesthetics
Bacterial pneumonia
Biology and Life Sciences
Blood pressure
Body mass index
Care and treatment
Comorbidity
Complications and side effects
Critical Illness
Disease
Extracorporeal membrane oxygenation
Hospitalization
Hospitals
Humans
Hypoxemia
Hypoxia
Mechanical ventilation
Medical records
Medicine and Health Sciences
Mortality
Narcotics
Neuromuscular Blockade
Neuromuscular blocking agents
Neuromuscular Diseases
Ostomy
Patient outcomes
Patients
Pneumonia
Pneumonia - complications
Regression analysis
Renal replacement therapy
Respiration, Artificial
Retrospective Studies
Risk analysis
Risk factors
Steroids
Tracheotomy
Ventilation
Ventilators
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Summary:The benefit of neuromuscular blockades (NMBs) in critically ill patients receiving mechanical ventilation remains uncertain. Therefore, we aimed to investigate whether NMB use is associated with improved survival of mechanically ventilated pneumonia patients with moderate to severe hypoxemia. This retrospective multicenter study was conducted at five university-affiliated hospitals. Data of pneumonia patients aged 18 years and older who received mechanical ventilation between January 1, 2011, and December 31, 2020, were analyzed. In a total of 1,130 patients, the mean patient age was 73.1 years (SD±12.6), and the overall mortality rate at 30 d was 29.5% (n = 333). NMB users had a higher 30 d mortality rate than NMB nonusers (33.9% vs. 26.8%, P = 0.014). After PS matching, the 30 d mortality rate was not significantly different between NMB users and nonusers (33.4% vs. 27.8%, p = 0.089). However, 90 d mortality rate was significantly increased in NMB users (39.7% vs. 31.9%, p = 0.021). Univariable Cox proportional hazard regression analyses showed that NMB use ≥ 3 d was significant risk factor for the 90 d mortality than those with < 3 d use (90 d mortality HR 1.39 [95% CI: 1.01-1.91], P = 0.045). NMB use was not associated with lower 30 d mortality among mechanically ventilated pneumonia patients with moderate to severe hypoxemia. Rather, NMB users had higher 90 d mortality, furthermore, and NMB use ≥ 3 d was associated with a higher risk of long-term mortality compared to NMB use < 3 d. Therefore, care should be taken to avoid extended use of NMB in critically ill pneumonia patients during mechanical ventilation.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0277503