Barmparas Galinos, Dhillon Navpreet K, Tatum James M, Patel Kavita, Thomsen Gretchen M, Mason Russell, Margulies Daniel R, Ley Eric J
Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
J Surg Res. 2018 Nov;231:434-440. doi: 10.1016/j.jss.2018.06.074. Epub 2018 Aug 7.
Neuromuscular blockade (NMB) is often utilized in the treatment of acute respiratory distress syndrome (ARDS). Its use for a period of 48 h has been shown to improve mortality in randomized control trials. We aimed to characterize outcomes associated with a prolonged NMB. We hypothesized that the duration of NMB would not be associated with increased mortality.
This was a retrospective review from June 2014 to October 2016 of patients admitted to the surgical intensive care unit and receiving cisatracurium for ARDS. Patients paralyzed for ≤ 48 h (SHORT) were compared to those paralyzed for longer durations (LONG). Primary outcome was mortality. Parametric and nonparametric tests were utilized for the purposes of the comparison. A multivariate logistic regression model was utilized to adjust for differences.
Of 73 patients meeting inclusion criteria, 32 (44%) were SHORT and 41 (56%) LONG. Compared to the LONG cohort, those in SHORT were older (60 versus 52 years, P = 0.04) but were comparable with respect to sex, acute physiology and chronic health evaluation IV scores, presence of concurrent pneumonia, and the use of vasopressors. SHORT patients were less likely to require rescue therapy with inhaled nitric oxide (28% versus 66%, P < 0.01). Overall mortality was 60%. There was no difference in the adjusted odds for mortality (adjusted odds ratio: 0.57, P = 0.33). Secondary outcomes including deep venous thrombosis and pneumonia did not differ between the two groups.
Extended NMB for ARDS was not associated with increased mortality. Discontinuation of this modality should not be based solely on the duration of therapy.
神经肌肉阻滞（NMB）常用于治疗急性呼吸窘迫综合征（ARDS）。在随机对照试验中，使用48小时已显示可改善死亡率。我们旨在描述与延长NMB相关的结局。我们假设NMB的持续时间与死亡率增加无关。
这是一项对2014年6月至2016年10月入住外科重症监护病房并因ARDS接受顺式阿曲库铵治疗的患者的回顾性研究。将麻痹时间≤48小时的患者（SHORT组）与麻痹时间更长的患者（LONG组）进行比较。主要结局是死亡率。为进行比较采用了参数检验和非参数检验。使用多因素逻辑回归模型来调整差异。
在73名符合纳入标准的患者中，32名（44%）为SHORT组，41名（56%）为LONG组。与LONG组相比，SHORT组患者年龄更大（60岁对52岁，P = 0.04），但在性别、急性生理学与慢性健康状况评估IV评分、是否并发肺炎以及是否使用血管加压药方面具有可比性。SHORT组患者需要吸入一氧化氮进行抢救治疗的可能性较小（28%对66%，P < 0.01）。总体死亡率为60%。调整后的死亡几率无差异（调整后的优势比：0.57，P = 0.33）。包括深静脉血栓形成和肺炎在内的次要结局在两组之间没有差异。
ARDS患者延长NMB与死亡率增加无关。不应仅基于治疗持续时间而停用这种治疗方式。
