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Treatment with neuromuscular blocking agents and the risk of in-hospital mortality among mechanically ventilated patients with severe sepsis.
Crit Care Med. 2014 Jan; 42(1):90-6.CC

Abstract

OBJECTIVES

Recent trials suggest that treatment with neuromuscular blocking agents may improve survival in patients requiring mechanical ventilation for acute respiratory distress syndrome. We examined the association between receipt of a neuromuscular blocking agent and in-hospital mortality among mechanically ventilated patients with severe sepsis.

DESIGN

A pharmacoepidemiologic cohort study of patients with sepsis and a respiratory infection who had been admitted to intensive care and placed on mechanical ventilation within the first 2 days of hospitalization. We used propensity score matching and instrumental variable methods to compare the outcomes of patients treated with neuromuscular blocking agents within the first 2 hospital days to those who were not. Sensitivity analysis was used to model the effects of a hypothetical unmeasured confounder.

SETTING

Three hundred thirty-nine U.S. hospitals that participated in the Premier Perspective database between 2004 and 2006.

PATIENTS

Seven thousand eight hundred sixty-four patients met inclusion criteria, including 1,818 (23%) who were treated with a neuromuscular blocking agent by hospital day 2.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Patients who received neuromuscular blocking agents were younger (mean age, 62 vs 68), more likely to be treated with vasopressors (69% vs 65%) and had a lower in-hospital mortality rate (31.9% vs 38.3%, p < 0.001). In 3,518 patients matched on the propensity for treatment, receipt of a neuromuscular blocking agent was associated with a reduced risk of in-hospital mortality (risk ratio, 0.88; 95% CI, 0.80, 0.96). An analysis using the hospital neuromuscular blocking agent-prescribing rate as an instrumental variable found receipt of a neuromuscular blocking agent associated with a 4.3% (95% CI, -11.5%, 1.5%) reduction in in-hospital mortality.

CONCLUSIONS

Among mechanically ventilated patients with severe sepsis and respiratory infection, early treatment with a neuromuscular blocking agent is associated with lower in-hospital mortality.

Authors+Show Affiliations

1Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, MA. 2Department of Medicine, Tufts University School of Medicine, Boston, MA. 3Center for Quality of Care Research, Baystate Medical Center, Springfield, MA. 4Division of General Medicine, Baystate Medical Center, Springfield, MA. 5Department of Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH. 6OptiStatim, LLC, Longmeadow, MA. 7Department of Anesthesiology, Duke University Medical Center Anesthesiology Service, Durham VA Medical Center, Durham, NC.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

23982029

Citation

Steingrub, Jay S., et al. "Treatment With Neuromuscular Blocking Agents and the Risk of In-hospital Mortality Among Mechanically Ventilated Patients With Severe Sepsis." Critical Care Medicine, vol. 42, no. 1, 2014, pp. 90-6.
Steingrub JS, Lagu T, Rothberg MB, et al. Treatment with neuromuscular blocking agents and the risk of in-hospital mortality among mechanically ventilated patients with severe sepsis. Crit Care Med. 2014;42(1):90-6.
Steingrub, J. S., Lagu, T., Rothberg, M. B., Nathanson, B. H., Raghunathan, K., & Lindenauer, P. K. (2014). Treatment with neuromuscular blocking agents and the risk of in-hospital mortality among mechanically ventilated patients with severe sepsis. Critical Care Medicine, 42(1), 90-6. https://doi.org/10.1097/CCM.0b013e31829eb7c9
Steingrub JS, et al. Treatment With Neuromuscular Blocking Agents and the Risk of In-hospital Mortality Among Mechanically Ventilated Patients With Severe Sepsis. Crit Care Med. 2014;42(1):90-6. PubMed PMID: 23982029.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment with neuromuscular blocking agents and the risk of in-hospital mortality among mechanically ventilated patients with severe sepsis. AU - Steingrub,Jay S, AU - Lagu,Tara, AU - Rothberg,Michael B, AU - Nathanson,Brian H, AU - Raghunathan,Karthik, AU - Lindenauer,Peter K, PY - 2013/8/29/entrez PY - 2013/8/29/pubmed PY - 2014/2/20/medline SP - 90 EP - 6 JF - Critical care medicine JO - Crit Care Med VL - 42 IS - 1 N2 - OBJECTIVES: Recent trials suggest that treatment with neuromuscular blocking agents may improve survival in patients requiring mechanical ventilation for acute respiratory distress syndrome. We examined the association between receipt of a neuromuscular blocking agent and in-hospital mortality among mechanically ventilated patients with severe sepsis. DESIGN: A pharmacoepidemiologic cohort study of patients with sepsis and a respiratory infection who had been admitted to intensive care and placed on mechanical ventilation within the first 2 days of hospitalization. We used propensity score matching and instrumental variable methods to compare the outcomes of patients treated with neuromuscular blocking agents within the first 2 hospital days to those who were not. Sensitivity analysis was used to model the effects of a hypothetical unmeasured confounder. SETTING: Three hundred thirty-nine U.S. hospitals that participated in the Premier Perspective database between 2004 and 2006. PATIENTS: Seven thousand eight hundred sixty-four patients met inclusion criteria, including 1,818 (23%) who were treated with a neuromuscular blocking agent by hospital day 2. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients who received neuromuscular blocking agents were younger (mean age, 62 vs 68), more likely to be treated with vasopressors (69% vs 65%) and had a lower in-hospital mortality rate (31.9% vs 38.3%, p < 0.001). In 3,518 patients matched on the propensity for treatment, receipt of a neuromuscular blocking agent was associated with a reduced risk of in-hospital mortality (risk ratio, 0.88; 95% CI, 0.80, 0.96). An analysis using the hospital neuromuscular blocking agent-prescribing rate as an instrumental variable found receipt of a neuromuscular blocking agent associated with a 4.3% (95% CI, -11.5%, 1.5%) reduction in in-hospital mortality. CONCLUSIONS: Among mechanically ventilated patients with severe sepsis and respiratory infection, early treatment with a neuromuscular blocking agent is associated with lower in-hospital mortality. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/23982029/Treatment_with_neuromuscular_blocking_agents_and_the_risk_of_in_hospital_mortality_among_mechanically_ventilated_patients_with_severe_sepsis_ L2 - https://dx.doi.org/10.1097/CCM.0b013e31829eb7c9 DB - PRIME DP - Unbound Medicine ER -