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Treatment with neuromuscular blocking agents and the risk of in-hospital mortality among mechanically ventilated patients with severe sepsis.

Publication ,  Journal Article
Steingrub, JS; Lagu, T; Rothberg, MB; Nathanson, BH; Raghunathan, K; Lindenauer, PK
Published in: Crit Care Med
January 2014

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.

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Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

January 2014

Volume

42

Issue

1

Start / End Page

90 / 96

Location

United States

Related Subject Headings

  • Sepsis
  • Risk Factors
  • Retrospective Studies
  • Respiration, Artificial
  • Propensity Score
  • Neuromuscular Blocking Agents
  • Middle Aged
  • Male
  • Humans
  • Hospital Mortality
 

Citation

APA
Chicago
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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. Crit Care Med, 42(1), 90–96. https://doi.org/10.1097/CCM.0b013e31829eb7c9
Steingrub, Jay S., Tara Lagu, Michael B. Rothberg, Brian H. Nathanson, Karthik Raghunathan, and Peter K. Lindenauer. “Treatment with neuromuscular blocking agents and the risk of in-hospital mortality among mechanically ventilated patients with severe sepsis.Crit Care Med 42, no. 1 (January 2014): 90–96. https://doi.org/10.1097/CCM.0b013e31829eb7c9.
Steingrub JS, Lagu T, Rothberg MB, Nathanson BH, Raghunathan K, Lindenauer PK. 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.
Steingrub, Jay S., et al. “Treatment with neuromuscular blocking agents and the risk of in-hospital mortality among mechanically ventilated patients with severe sepsis.Crit Care Med, vol. 42, no. 1, Jan. 2014, pp. 90–96. Pubmed, doi:10.1097/CCM.0b013e31829eb7c9.
Steingrub JS, Lagu T, Rothberg MB, Nathanson BH, Raghunathan K, Lindenauer PK. 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):90–96.

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

January 2014

Volume

42

Issue

1

Start / End Page

90 / 96

Location

United States

Related Subject Headings

  • Sepsis
  • Risk Factors
  • Retrospective Studies
  • Respiration, Artificial
  • Propensity Score
  • Neuromuscular Blocking Agents
  • Middle Aged
  • Male
  • Humans
  • Hospital Mortality