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Research ArticleOriginal Research

A Survey of Academic Intensivists' Use of Neuromuscular Blockade in Subjects With ARDS

Neal N Dodia, Mary E Richert, Andrew R Deitchman, Charlene C Quinn, Ellen T Marciniak, Clayton H Brown, Michael L Terrin, Diana E Amariei, Carl B Shanholtz and Jeffrey D Hasday
Respiratory Care September 2019, respcare.07026; DOI: https://doi.org/10.4187/respcare.07026
Neal N Dodia
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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Mary E Richert
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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Andrew R Deitchman
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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Charlene C Quinn
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
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Ellen T Marciniak
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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Clayton H Brown
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
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Michael L Terrin
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
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Diana E Amariei
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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Carl B Shanholtz
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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Jeffrey D Hasday
Baltimore Veterans Administration Medical Center, Baltimore, Maryland.
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  • For correspondence: jhasday@medicine.umaryland.edu
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Abstract

BACKGROUND: Our Cooling to Help Injured Lungs (CHILL) trial of therapeutic hypothermia in ARDS includes neuromuscular blockade (NMB) as an inclusion criterion to avoid shivering. NMB has been used to facilitate mechanical ventilation in ARDS and was shown to reduce mortality in the ACURASYS trial. To assess the feasibility of a multi-center CHILL trial, we conducted a survey of academic intensivists about their NMB use in patients with ARDS.

METHODS: We distributed via email a 16-question survey about NMB use in patients with ARDS including frequency, indications, and dosing strategy.

RESULTS: 212 (24.3%) of 871 respondents completed the survey: 94.7% were board-certified in internal medicine, 88% in pulmonary and critical care; 90.3% practiced in academic medical centers, with 87% working in medical ICUs; 96.6% of respondents who treat ARDS use NMB, and 39.7% use NMB in ≥ 50% of these patients. Of 4 listed indications for initiating NMB in ARDS, allowing adherence with lung-protective ventilator strategies and patient–ventilator synchrony were cited as the most important reasons, followed by the results of the ACURASYS trial and facilitating prone positioning.

CONCLUSIONS: We conclude that NMB is frequently used by academic intensivists to facilitate mechanical ventilation in patients with moderate to severe ARDS.

  • neuromuscular blockade
  • acute respiratory distress syndrome
  • survey
  • intensivist
  • ACURASYS trial
  • lung-protective ventilation
  • mechanical ventilation

Footnotes

  • Correspondence: Jeffrey D Hasday MD, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St, Room 2N149, Baltimore, MD 21201. E-mail: jhasday{at}medicine.umaryland.edu.
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2019 by Daedalus Enterprises

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In this issue

Respiratory Care: 64 (12)
Respiratory Care
Vol. 64, Issue 12
1 Dec 2019
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A Survey of Academic Intensivists' Use of Neuromuscular Blockade in Subjects With ARDS
Neal N Dodia, Mary E Richert, Andrew R Deitchman, Charlene C Quinn, Ellen T Marciniak, Clayton H Brown, Michael L Terrin, Diana E Amariei, Carl B Shanholtz, Jeffrey D Hasday
Respiratory Care Sep 2019, respcare.07026; DOI: 10.4187/respcare.07026

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A Survey of Academic Intensivists' Use of Neuromuscular Blockade in Subjects With ARDS
Neal N Dodia, Mary E Richert, Andrew R Deitchman, Charlene C Quinn, Ellen T Marciniak, Clayton H Brown, Michael L Terrin, Diana E Amariei, Carl B Shanholtz, Jeffrey D Hasday
Respiratory Care Sep 2019, respcare.07026; DOI: 10.4187/respcare.07026
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Keywords

  • neuromuscular blockade
  • acute respiratory distress syndrome
  • survey
  • intensivist
  • ACURASYS trial
  • lung-protective ventilation
  • mechanical ventilation

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