Alexandra Wiegand, PharmD
PGY2 Critical Care Pharmacy Resident
University of Kentucky Albert B Chandler Hospital
Lexington, Kentucky
Disclosure information not submitted.
Melissa Thompson Bastin, BCCCP, PharmD, PhD
University of Kentucky HealthCare
Lexington, Kentucky
Disclosure information not submitted.
Adam Cole, MD
Pulmonary Critical Care and Sleep Medicine Physician
University of Kentucky HealthCare, United States
Disclosure information not submitted.
Aric Schadler, PhD
Statistician
University of Kentucky, United States
Disclosure information not submitted.
Tori Gray, n/a
PharmD Candidate
University of Kentucky College of Pharmacy, United States
Disclosure information not submitted.
J. Chris Donaldson, BCCCP, PharmD
Pharmacist
University of Kentucky HealthCare, United States
Disclosure information not submitted.
Christian Kressin, BCCCP, PharmD
Pharmacist
University of Kentucky HealthCare
Lexington, United States
Disclosure information not submitted.
Elizabeth Bonnet, MSN, RN, CCRN-K, RN-BC
Clinical Nurse Specialist
University of Kentucky HealthCare, United States
Disclosure information not submitted.
Breanne Mefford, PharmD,
Pharmacist
University of Kentucky Healthcare
Lexington, Kentucky
Disclosure information not submitted.
Title: Impact of Proning on Paralyzed Patients with Acute Respiratory Distress Syndrome
Introduction:
Continuous neuromuscular blockade and prone positioning are treatment strategies utilized for acute respiratory distress syndrome (ARDS), however the incidence of these interventions occurring simultaneously in large clinical trials is variable. The objective of this study was to compare whether paralysis alone or combination proning and paralysis improve oxygenation and outcomes in patients with ARDS.
Methods:
This was a single-center, retrospective, matched cohort study at the University of Kentucky (UK) Chandler Medical Center, a 945-bed hospital in Lexington, KY. Adult patients ≥ 18 years old, admitted to the Medical Intensive Care Unit (MICU) from January 1st, 2016 to October 31st, 2020 receiving continuous infusion (CI) cisatracurium or combination CI cisatracurium and prone positioning for ARDS were included. The primary outcome was the PaO2/FiO2 assessed at 24 and 48-hours following intervention. Secondary outcomes included ventilator free days at 28 days, hospital mortality at 28 days, hospital and MICU length of stay, and rate of tracheostomies.
Results:
After one-to-one nearest-neighbor matching from 188 identified patients, 35 patients in each group were included in the analysis. Baseline characteristics of the overall matched cohort included median baseline Sequential Organ Failure Assessment (SOFA) score of 10.5 (IQR 8 -14), median baseline PaO2/FiO2 of 80 (IQR 72-96), and median baseline positive end-expiratory pressure (PEEP) of 16 cm H2O (IQR 12.5-18). In-hospital mortality occurred in 32 of 70 patients (46%). Utilizing repeated-measures analysis of variance, the combination of proning and paralysis was not associated with improvement in PaO2/FiO2 assessed at 24 and 48-hours compared with paralysis alone. No differences in secondary or safety outcomes were observed between groups.
Conclusion:
Treatment with combination prone positioning and paralysis was not associated with improvement in PaO2/FiO2 compared to those who received paralysis alone.