Neuromuscular blockade and oxygenation changes during prone positioning in COVID-19
Copyright © 2023 Elsevier Inc. All rights reserved..
PURPOSE: Neuromuscular blockers (NMBs) are often used during prone positioning to facilitate mechanical ventilation in COVID-19 related ARDS. However, their impact on oxygenation is uncertain.
METHODS: Multi-centre observational study of invasively ventilated COVID-19 ARDS adults treated with prone positioning. We collected data on baseline characteristics, prone positioning, NMB use and patient outcome. We assessed arterial blood gas data during supine and prone positioning and after return to the supine position.
RESULTS: We studied 548 prone episodes in 220 patients (mean age 54 years, 61% male) of whom 164 (75%) received NMBs. Mean PaO2:FiO2 (P/F ratio) during the first prone episode with NMBs reached 208 ± 63 mmHg compared with 161 ± 66 mmHg without NMBs (Δmean = 47 ± 5 mmHg) for an absolute increase from baseline of 76 ± 56 mmHg versus 55 ± 56 mmHg (padj < 0.001). The mean P/F ratio on return to the supine position was 190 ± 63 mmHg in the NMB group versus 141 ± 64 mmHg in the non-NMB group for an absolute increase from baseline of 59 ± 58 mmHg versus 34 ± 56 mmHg (padj < 0.001).
CONCLUSION: During prone positioning, NMB is associated with increased oxygenation compared to non-NMB therapy, with a sustained effect on return to the supine position. These findings may help guide the use of NMB during prone positioning in COVID-19 ARDS.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:79 |
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| Enthalten in: |
Journal of critical care - 79(2024) vom: 15. Feb., Seite 154469 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Rollinson, Thomas C [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 09.01.2024 Date Revised 18.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jcrc.2023.154469 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM364837349 |
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| 100 | 1 | |a Rollinson, Thomas C |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Neuromuscular blockade and oxygenation changes during prone positioning in COVID-19 |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 09.01.2024 | ||
| 500 | |a Date Revised 18.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Elsevier Inc. All rights reserved. | ||
| 520 | |a PURPOSE: Neuromuscular blockers (NMBs) are often used during prone positioning to facilitate mechanical ventilation in COVID-19 related ARDS. However, their impact on oxygenation is uncertain | ||
| 520 | |a METHODS: Multi-centre observational study of invasively ventilated COVID-19 ARDS adults treated with prone positioning. We collected data on baseline characteristics, prone positioning, NMB use and patient outcome. We assessed arterial blood gas data during supine and prone positioning and after return to the supine position | ||
| 520 | |a RESULTS: We studied 548 prone episodes in 220 patients (mean age 54 years, 61% male) of whom 164 (75%) received NMBs. Mean PaO2:FiO2 (P/F ratio) during the first prone episode with NMBs reached 208 ± 63 mmHg compared with 161 ± 66 mmHg without NMBs (Δmean = 47 ± 5 mmHg) for an absolute increase from baseline of 76 ± 56 mmHg versus 55 ± 56 mmHg (padj < 0.001). The mean P/F ratio on return to the supine position was 190 ± 63 mmHg in the NMB group versus 141 ± 64 mmHg in the non-NMB group for an absolute increase from baseline of 59 ± 58 mmHg versus 34 ± 56 mmHg (padj < 0.001) | ||
| 520 | |a CONCLUSION: During prone positioning, NMB is associated with increased oxygenation compared to non-NMB therapy, with a sustained effect on return to the supine position. These findings may help guide the use of NMB during prone positioning in COVID-19 ARDS | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a ARDS | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Hypoxemia | |
| 650 | 4 | |a Intensive care unit | |
| 650 | 4 | |a NMBA | |
| 650 | 4 | |a Neuromuscular blockade | |
| 650 | 4 | |a Positioning | |
| 650 | 4 | |a Prone | |
| 650 | 4 | |a Prone positioning | |
| 650 | 4 | |a Respiratory failure | |
| 700 | 1 | |a McDonald, Luke A |e verfasserin |4 aut | |
| 700 | 1 | |a Rose, Joleen |e verfasserin |4 aut | |
| 700 | 1 | |a Eastwood, Glenn |e verfasserin |4 aut | |
| 700 | 1 | |a Costa-Pinto, Rahul |e verfasserin |4 aut | |
| 700 | 1 | |a Modra, Lucy |e verfasserin |4 aut | |
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| 700 | 1 | |a Dumbrell, Jodi |e verfasserin |4 aut | |
| 700 | 1 | |a French, Craig |e verfasserin |4 aut | |
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| 700 | 1 | |a Haines, Kimberley |e verfasserin |4 aut | |
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