Journal article
Sedation Practices During Continuous Neuromuscular Blockade for Acute Respiratory Distress Syndrome
Annals of the American Thoracic Society, Vol.22(9), pp.1394-1400
09/2025
DOI: 10.1513/AnnalsATS.202411-1225OC
PMCID: PMC12416150
PMID: 40344163
Abstract
Neuromuscular blockade is frequently used during acute respiratory distress syndrome (ARDS) to improve ventilator synchrony. Which sedating medications are used concomitantly during neuromuscular blockade and whether sedation choice influences patient outcomes are unclear.
To determine national sedation practice patterns during neuromuscular blockade in patients with and at risk for ARDS, and to establish whether use of propofol and opioids compared with benzodiazepines and opioids is associated with improved outcomes.
Using a U.S. national database from years 2010-2021, intubated and mechanically ventilated patients receiving neuromuscular blockade for a diagnosis of ARDS or an ARDS risk factor over at least two hospital days after admission were included. Charges for sedation and analgesia during the first two hospital days were recorded for each patient. The relationship between propofol and opioid versus benzodiazepine and opioid, with a primary outcome of ventilator free days as well as secondary outcomes of 28-day survival and discharge home were examined in multivariable analyses.
We determined that propofol has increased compared to benzodiazepines as the primary sedative utilized during neuromuscular blockade for ARDS. Compared to benzodiazepine and opioid use, propofol and opioid use during neuromuscular blockade for ARDS was associated with increased ventilator free days (adjusted odds ratio 1.38, 95% confidence interval 1.24 - 1.54), greater odds for survival at 28 days (adjusted odds ratio 1.15, 95% confidence interval 1.01- 1.31), and greater odds for discharge home (adjusted odds ratio 1.26, 95% confidence interval 1.09 - 1.46) adjusting for patient-level and hospital-level characteristics.
From 2010-2021, sedation practice during neuromuscular blockade for ARDS has shifted from predominately benzodiazepine use to predominately propofol use. Use of propofol and opioid is associated with an increase in ventilator free days compared to use of benzodiazepine and opioid. These results suggest that sedation choice during NMB for ARDS may impact clinical outcomes; further investigation is needed to validate these findings.
Details
- Title: Subtitle
- Sedation Practices During Continuous Neuromuscular Blockade for Acute Respiratory Distress Syndrome
- Creators
- Peter J Dunbar - University of Colorado Anschutz Medical CampusRyan A Peterson - Colorado School of Public HealthMax McGrath - University of Colorado Anschutz Medical CampusTyree H Kiser - University of Colorado Anschutz Medical CampusP Michael Ho - University of Colorado Anschutz Medical CampusR William Vandivier - University of Colorado DenverEllen L Burnham - University of Colorado DenverMarc Moss - University of Colorado DenverPeter D Sottile - University of Colorado Denver
- Resource Type
- Journal article
- Publication Details
- Annals of the American Thoracic Society, Vol.22(9), pp.1394-1400
- DOI
- 10.1513/AnnalsATS.202411-1225OC
- PMID
- 40344163
- PMCID
- PMC12416150
- NLM abbreviation
- Ann Am Thorac Soc
- ISSN
- 2329-6933
- eISSN
- 2325-6621
- Publisher
- American Thoracic Society
- Grant note
- Institutional National Research Service Award - National Institute of Health, National Heart, Lung, and Blood Institute: T32 HL007085
Supported by an Institutional National Research Service Award (T32) funded by the National Institute of Health, National Heart, Lung, and Blood Institute (T32 HL007085).
- Language
- English
- Electronic publication date
- 05/09/2025
- Date published
- 09/2025
- Academic Unit
- Biostatistics; Internal Medicine
- Record Identifier
- 9984920372102771
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