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Research ArticleOriginal Research

Lower Driving Pressure and Neuromuscular Blocker Use Are Associated With Decreased Mortality in Patients With COVID-19 ARDS

Bo Young Lee, Song-I Lee, Moon Seong Baek, Ae-Rin Baek, Yong Sub Na, Jin Hyoung Kim, Gil Myeong Seong and Won-Young Kim
Respiratory Care February 2022, 67 (2) 216-226; DOI: https://doi.org/10.4187/respcare.09577
Bo Young Lee
Division of Allergy and Respiratory Diseases, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
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Song-I Lee
Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
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Moon Seong Baek
Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
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Ae-Rin Baek
Division of Allergy and Pulmonology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
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Yong Sub Na
Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju, Republic of Korea.
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Jin Hyoung Kim
Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
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Gil Myeong Seong
Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea.
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Won-Young Kim
Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: The impact of mechanical ventilation parameters and management on outcomes of patients with coronavirus disease 2019 (COVID-19) ARDS is unclear.

METHODS: This multi-center observational study enrolled consecutive mechanically ventilated patients with COVID-19 ARDS admitted to one of 7 Korean ICUs between February 1, 2020–February 28, 2021. Patients who were age < 17 y or had missing ventilation parameters for the first 4 d of mechanical ventilation were excluded. Multivariate logistic regression was used to identify which strategies or ventilation parameters that were independently associated with ICU mortality.

RESULTS: Overall, 129 subjects (males, 60%) with a median (interquartile range) age of 69 (62–78) y were included. Neuromuscular blocker (NMB) use and prone positioning were applied to 76% and 16% of subjects, respectively. The ICU mortality rate was 37%. In the multivariate analysis, higher dynamic driving pressure (ΔP) values during the first 4 d of mechanical ventilation were associated with increased mortality (adjusted odds ratio 1.16 [95% CI 1.00–1.33], P = .046). NMB use was associated with decreased mortality (adjusted odds ratio 0.27 [95% CI 0.09–0.81], P = .02). The median tidal volume values during the first 4 d of mechanical ventilation and the ICU mortality rate were significantly lower in the NMB group than in the no NMB group. However, subjects who received NMB for ≥ 6 d (vs < 6 d) had higher ICU mortality rate.

CONCLUSIONS: In subjects with COVID-19 ARDS receiving mechanical ventilation, ΔP during the first 4 d of mechanical ventilation was independently associated with mortality. The short-term use of NMB facilitated lung-protective ventilation and was independently associated with decreased mortality.

  • COVID-19
  • driving pressure
  • mechanical ventilation
  • neuromuscular blockade
  • respiratory distress syndrome
  • SARS-CoV-2

Footnotes

  • Correspondence: Won-Young Kim MD PhD, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea. E-mail: wykim81{at}cau.ac.kr
  • The authors have disclosed no conflicts of interest.

  • This research was supported by a National Research Foundation of Korea grant funded by the Korea government (MSIP) (2019R1G1A1099373).

  • Supplementary material related to this paper is available at http://rc.rcjournal.com.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (2)
Respiratory Care
Vol. 67, Issue 2
1 Feb 2022
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Lower Driving Pressure and Neuromuscular Blocker Use Are Associated With Decreased Mortality in Patients With COVID-19 ARDS
Bo Young Lee, Song-I Lee, Moon Seong Baek, Ae-Rin Baek, Yong Sub Na, Jin Hyoung Kim, Gil Myeong Seong, Won-Young Kim
Respiratory Care Feb 2022, 67 (2) 216-226; DOI: 10.4187/respcare.09577

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Lower Driving Pressure and Neuromuscular Blocker Use Are Associated With Decreased Mortality in Patients With COVID-19 ARDS
Bo Young Lee, Song-I Lee, Moon Seong Baek, Ae-Rin Baek, Yong Sub Na, Jin Hyoung Kim, Gil Myeong Seong, Won-Young Kim
Respiratory Care Feb 2022, 67 (2) 216-226; DOI: 10.4187/respcare.09577
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Keywords

  • COVID-19
  • driving pressure
  • mechanical ventilation
  • neuromuscular blockade
  • respiratory distress syndrome
  • SARS-CoV-2

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