1. Utilization and effect of neuromuscular blockade in a randomized trial of high-frequency oscillation
- Author
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Neill K. J. Adhikari, Jan O. Friedrich, Niall D. Ferguson, Maureen O. Meade, François Lamontagne, Ruxandra Pinto, Qi Zhou, and Sangeeta Mehta
- Subjects
Excess mortality ,Neuromuscular Blockade ,Randomization ,Oscillatory ventilation ,Proportional hazards model ,business.industry ,Sedation ,High-Frequency Ventilation ,High frequency oscillation ,Critical Care and Intensive Care Medicine ,law.invention ,Intensive Care Units ,Randomized controlled trial ,law ,Anesthesia ,medicine ,Humans ,Hospital Mortality ,medicine.symptom ,business - Abstract
We evaluated characteristics associated with neuromuscular blockade (NMB) use, center-level variation, and whether NMB mediated excess mortality among patients assigned to high-frequency oscillatory ventilation (HFOV) in the OSCILLATE trial.NMB exposure was defined as receipt after randomization; the primary outcome was hospital mortality. Descriptive analyses compared NMB-exposed vs unexposed patients. Multivariable analyses included patients not on baseline NMB. Cox regression evaluated associations of patient- and center-level variables with NMB use. A log-normal frailty model evaluated center effects. Mediation analysis examined the effect of NMB in HFOV-assigned patients.376/548 patients (39 centers) received post-randomization NMB, of whom 165 received baseline NMB. Patients receiving post-randomization NMB (vs. not) had worse lung mechanics and gas exchange, received more sedation and vasopressors (p 0.05), and had higher hospital mortality (44% vs. 34%, p = 0.03). Mean airway pressure ≥ 24 cmHIn OSCILLATE, receipt of post-randomization NMB was associated with worse outcomes, but NMB use did not mediate HFOV-associated higher mortality.
- Published
- 2021