Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34331
Title: Neuromuscular blockade and oxygenation changes during prone positioning in COVID-19.
Austin Authors: Rollinson, Thomas C ;McDonald, Luke A ;Rose, Joleen W ;Eastwood, Glenn M ;Costa-Pinto, Rahul;Modra, Lucy J ;Maeda, Akinori;Bacolas, Zoe;Anstey, James;Bates, Samantha;Bradley, Scott;Dumbrell, Jodi;French, Craig;Ghosh, Angaj;Haines, Kimberley J ;Haydon, Tim;Hodgson, Carol L;Holmes, Jennifer;Leggett, Nina;McGain, Forbes;Moore, Cara;Nelson, Kathleen;Presneill, Jeffrey;Rotherham, Hannah;Said, Simone;Young, Meredith;Zhao, Peinan;Udy, Andrew;Neto, Ary Serpa;Chaba, Anis;Bellomo, Rinaldo 
Affiliation: Intensive Care
Physiotherapy
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
Data Analytics Research and Evaluation (DARE) Centre
Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia.
Department of Intensive Care, Alfred Health, VIC, Australia; Department of Physiotherapy, Alfred Health, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia.
Department of Intensive Care, Northern Health, VIC, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia; Department of Physiotherapy, Western Health, VIC, Australia.
Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Health, VIC, Australia; Department of Physiotherapy, Alfred Health, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Department of Physiotherapy, Alfred Health, VIC, Australia.
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Department of Intensive Care, Northern Health, VIC, Australia.
Department of Intensive Care, Alfred Health, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
Department of Intensive Care, Alfred Health, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
Issue Date: 21-Nov-2023
Date: 2023
Publication information: Journal of Critical Care 2023-11-21; 79
Abstract: 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. 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. 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). 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.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34331
DOI: 10.1016/j.jcrc.2023.154469
ORCID: 
Journal: Journal of Critical Care
Start page: 154469
PubMed URL: 37992464
ISSN: 1557-8615
Type: Journal Article
Subjects: ARDS
COVID-19
Hypoxemia
Intensive care unit
NMBA
Neuromuscular blockade
Positioning
Prone
Prone positioning
Respiratory failure
Appears in Collections:Journal articles

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