Association Between Rocuronium Administration and Clinical Outcomes in Patients With Moderate-To-Severe Acute Respiratory Distress Syndrome: A Retrospective Cohort Study
Abstract
Background: Neuromuscular blocking agents (NMBAs) are commonly used to manage acute respiratory distress syndrome (ARDS). However, the efficacy of continuous NMBA administration other than cisatracurium remains understudied. Objective: To examine the association between continuous rocuronium administration and clinical outcomes in patients with moderate-to-severe ARDS. Methods: A retrospective cohort study was performed using data from a Japanese national inpatient database (April 2018-March 2022). Adult patients with pneumonia requiring mechanical ventilation in the intensive care unit (ICU), with respiratory Sequential Organ Failure Assessment score of ≥3 were included. The patients were divided into those receiving continuous rocuronium (exposure group) and those not receiving any continuous NMBAs (comparison group). The association between continuous rocuronium administration and outcomes was analyzed using multivariable regression analyses fitted with generalized estimating equations. Results: Among 1992 eligible patients, 124 received rocuronium. In-hospital mortality were 30.8% and 25.8% in the comparison and exposure groups, respectively. No significant differences observed in in-hospital mortality (odds ratio [OR] 0.70; 95% confidence interval [CI]: 0.42 to 1.19), ICU mortality (9.0% vs 8.9%, OR 0.87; 95% CI: 0.41 to 1.87), median length of hospital stay (26 vs 28 days, %change 10.5; 95% CI: −8.9 to 34.1), ICU stay (8 vs 10 days, %change 9.0; 95% CI: −4.3 to 24.2),…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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