Neuromuscular Blocking Agents for ARDS: A Systematic Review and Meta-Analysis

Torbic, Heather; Krishnan, Sudhir; Harnegie, Mary Pat; Duggal, Abhijit

doi:10.4187/respcare.07849

Cited by 22 publications

(16 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Em metanálise publicada por Torbic, et al, (2021), os autores descrevem que embora o uso do bloqueador neuromuscular tenha reduzido o risco de mortalidade a curto prazo, risco de barotrauma e pneumotórax, não foi encontrado o mesmo resultado na análise de mortalidade a longo prazo (90 dias) em comparação com o grupo controle.…”

Section: Resultsunclassified

Perfil epidemiológico e desfecho clínico de pacientes internados com COVID-19 em um Hospital Universitário de Campo Grande – MS

Deitos

Lima²,

Pereira

et al. 2022

RSD

View full text Add to dashboard Cite

Objetivo: pesquisar as características sociodemográficas, presença de comorbidades, estratégias de manejo clínico e suas relações com desfecho (óbito/alta) de pacientes internados em Unidade de Terapia Intensiva por COVID-19 no HUMAP-MS no período de fevereiro de 2020 a setembro de 2021. Metodologia: estudo epidemiológico observacional, descritivo, transversal e de caráter retrospectivo, com abordagem quantitativa na coleta, realizado através da análise de prontuários físicos/digitais de pacientes admitidos no CTI COVID do HUMAP-MS, localizado em Campo Grande - MS, no período de fevereiro de 2020 a setembro de 2021. Resultados: Participaram do estudo 172 pacientes, divididos em dois grupos, de acordo com o desfecho clínico observado, sendo eles: Grupo Óbito (n=96) e Grupo Alta Hospitalar (n=76). Na comparação dos dois grupos estudados, o grupo óbito apresentou média de idade superior (p= 0,0001), maior prevalência de comorbidades (p= 0,0038), maior necessidade de intubação orotraqueal (p= 0,0026), e maior necessidade de utilização de BNM (p= 0,0409). Indivíduos com idade superior a 60 anos apresentaram aumento de 58% de risco de óbito. O grupo alta hospitalar apresentou maior número de dias de internação (p= 0,0007). Conclusão: Na amostra estudada a média de idade, presença de comorbidades, necessidade de intubação e da utilização de BNM foram fatores prevalecentes nos indivíduos que evoluíram com o desfecho clínico de óbito em decorrência da infecção por COVID19.

show abstract

Section: Resultsunclassified

Perfil epidemiológico e desfecho clínico de pacientes internados com COVID-19 em um Hospital Universitário de Campo Grande – MS

Deitos

Lima²,

Pereira

et al. 2022

RSD

View full text Add to dashboard Cite

show abstract

“…This necessitates that both patients are sedated and paralysed. Paralysis is not helpful beyond short time-frames [27] in a critical care patient, and the risk of undue muscular atrophy must be carefully considered when embarking on a course of care that necessitates paralysis. An ideal solution would allow the titration of as many respiratory parameters as possible, could respond to changes in lung mechanics of patients, and accommodate as wide a range of patients as possible, whilst facilitating lung protective ventilation.…”

Section: Discussionmentioning

confidence: 99%

Development and assessment of the performance of a shared ventilatory system that uses clinically available components to individualize tidal volumes

Hannon

Jones

Judge

et al. 2020

Preprint

View full text Add to dashboard Cite

ObjectivesTo develop and assess the performance of a system for shared ventilation that uses clinically available components to individualize tidal volumes under a variety of clinically relevant conditions.DesignEvaluation and in vitro validation study.SettingVentilator shortage during the SARS-CoV-2 global pandemic.ParticipantsThe design and validation team consisted of intensive care physicians, bioengineers, computer programmers, and representatives from the medtech sector.MethodsUsing standard clinical components, a system of shared ventilation consisting of two ventilatory limbs was assembled and connected to a single ventilator. Individual monitors for each circuit were developed using widely available equipment and open source software. System performance was determined under 2 sets of conditions. First, the effect of altering ventilator settings (Inspiratory Pressure, Respiratory rate, I:E ratio) on the tidal volumes delivered to each lung circuit was determined. Second, the impact of altering the compliance and resistance in one simulated lung circuit on the tidal volumes delivered to that lung and the second lung circuit was determined. All measurements at each setting were repeated three times to determine the variability in the system.ResultsThe system permitted accurate and reproducible titration of tidal volumes to each ‘lung circuit’ over a wide range of ventilator settings and simulated lung conditions. Alteration of ventilator inspiratory pressures stepwise from 4-20cm H2O, of respiratory rates from 6-20 breaths/minute and I:E ratio from 1:1 to 1:4 resulted in near identical tidal volumes delivered under each set of conditions to each simulated ‘lung’. Stepwise alteration of compliance and resistance in one ‘test’ lung circuit resulted in reproducible alterations in tidal volume to the ‘test’ lung, with little change to tidal volumes in the ‘control’ lung (a change of only 6% is noted). All tidal volumes delivered were highly reproducible upon repetition.ConclusionsWe demonstrate the reliability of a simple shared ventilation system assembled using commonly available clinical components that allows individual titration of tidal volumes. This system may be useful as a temporary strategy of last resort where the numbers of patients requiring invasive mechanical ventilation exceeds supply of ventilators.Article SummaryStrengths and limitations of this studyThis solution provides the ability to safely and robustly ventilate two patients simultaneously while allowing differing tidal volumes in each limb.The designed solution uses equipment readily available in most hospitals.Accurate and reproducible titration of tidal volumes to each ‘lung’ was possible over a wide range of ventilator settings.Alteration of one simulated ‘lung’ conditions had minimal impact on the tidal volumes delivered to the unaffected lungThe system relies on patients being sedated and paralysed.We have not yet tested this solution in vivo, on COVID-19 patients.

show abstract

“…The use of neuromuscular blockade (NMB) in patients with moderate to severe ARDS is associated with improved oxygenation, decreased ventilator associated lung injury, and improved mortality at 28 days, without increasing the incidence of neuromuscular weakness. 55 The most recent multicenter trial of NMB in ARDS (ROSE, data from which is included in reference 55), did not demonstrate a mortality benefit compared to a control group which only used light sedation, so routine use of NMB has been called into question. NMB use does require deep sedation, which is associated with increased mortality even after accounting for severity of illness, so this strategy must be employed cautiously.…”

Section: Diagnosismentioning

confidence: 99%