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Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis
Gianluigi Li Bassi, Kristen Gibbons, Jacky Y. Suen, Heidi J. Dalton, Nicole White, Amanda Corley, Sally Shrapnel, Samuel Hinton, Simon Forsyth, John G. Laffey, Eddy Fan, Jonathon P. Fanning, Mauro Panigada, Robert H. Bartlett, Daniel Brodie, Aidan Burrell, Davide Chiumello, Alyaa Elhazmi, Mariano Esperatti, Giacomo Grasselli, Carol Hodgson, Shingo Ichiba, Carlos Luna, Eva Miranda Marwali, Laura Merson, Srinivas Murthy, Alistair Nichol, Mark Ogino, Paolo Pelosi, Antoní Torres, Pauline Yeung Ng, John F. Fraser, Tala Al-dabbous, Huda Alfoudri, Mohammed Shamsah, Subbarao Elapavaluru, Ashley Berg, Christina Horn, Yunis Mayasi, Stephan Schroll, Dan M. Meyer, Jorge Velazco, Ludmyla Ploskanych, Wanda Fikes, Rohini Bagewadi, Marvin Dao, Ashley Ehlers, Maysoon Shalabi-McGuire, Trent Witt, Lorenzo Grazioli, Ferdinando Luca Lorini, E. Wilson Grandin, Jose I. 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Trisnaningrum, Vera Irawany, Muhammad Rayhan, Antonia Pesenti, Alberto Zanella, Michela Leone, Silvia Coppola, Sebastiano Maria Colombo, Massimo Antonelli, Simone Carelli, Domenico Luca Grieco, Motohiro Asaki, Kota Hoshino, Leonardo Salazar, Laura Duarte, David Cosgrave, Joseph McCaffrey, Allison Bone, Yusuff Hakeem, James Winearls, Mandy Tallott, David Thomson, Christel Arnold-Day, Jerome Cupido, Zainap Fanie, Malcom Miller, Lisa Seymore, Dawid van Straaten, Ali Ait Hssain, Jeffrey Aliudin, Al-Reem Alqahtani, Khoulod Mohamed, Ahmed Mohamed, Darwin Tan, Joy Villanueva, Ahmed Zaqout, Ethan Kurtzman, Arben Ademi, Ana Dobrita, Khadija El Aoudi, Juliet Segura, Gezy Giwangkancana, Shinichiro Ohshimo, Koji Hoshino, Javier Osatnik, Anne Joosten, Minlan Yang, Ana Motos, Francisco Arancibia, Virginie Williams, Alexandre Noël, Néstor Luque, Trieu Huynh Trung, Sophie Yacoub, Marina Fantini, Ruth Noemí Jorge García, Enrique Chicote Álvarez, Anna Greti, Adrián Ceccato, Ángel Sánchez Sánchez, Ana Loza Vázquez, Ferran Roche‐Campo, Diego Franch-Llasat, Divina Tuazon, Marcelo B. 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Owyang, Hergen Buscher, Claire Reynolds, Olavi Maasikas, Aleksan Beljantsev, Vladislav Mihnovitš, Takako Akimoto, Mariko Aizawa, Kanako Horibe, Ryota Onodera, Meredith Young, Timothy J. George, Kiran Shekar, Niki McGuinness, Lacey Irvine, Brigid C. Flynn, Tomoyuki Endo, Kazuhiro Sugiyama, Keiki Shimizu, Kathleen Exconde, Leslie Lussier, Gösta Lotz, Maximilian Malfertheiner, Lars S. Maier, Esther Dreier, Neurinda Permata Kusumastuti, Colin McCloskey, Al-Awwab Dabaliz, Tarek Elshazly, Josiah E. Smith, Konstanty Szułdrzyński, Piotr Bielański, Keith Wille, Ken Kuljit S. Parhar, Kirsten M. Fiest, Cassidy Codan, Anmol Shahid, Mohamed Fayed, Timothy Evans, Rebekah Garcia, Ashley Gutierrez, Hiroaki Shimizu, Tae Jin Song, Rebecca Rose, Suzanne Bennett, Denise Richardson, Giles J. Peek, Lovkesh Arora, Kristina Rappapport, Kristina Rudolph, Zita A. Sibenaller, Lori Stout, Alicia Walter, Daniel Herr, Nazli Vedadi, Shaun Thompson, Lace Sindt, Sean Rajnic, Cale Ewald, Julie Hoffman, Xiaonan Ying, Ryan Kennedy, Matthew Griffee, Anna Ciullo, Yuri Kida, Ricard Ferrer, Jordi Riera, Sofía Contreras, Cynthia Alegre, Christy Kay, I. Fischer, Elizabeth Renner, Hayato Taniguci, Adrian Barnett, India Pearse, Gabriella Abbate, Halah Hassan, Silver Heinsar, Varun A. Karnik, Katrina K. Ki, Hollier F. ONeill, Nchafatso G. Obonyo, Leticia Pretti Pimenta, Janice D. Reid, Kei Sato, Aapeli Vuorinen, Karin Wildi, Emily S. Wood, Stephanie T. Yerkovich, James Lee, Daniel Plotkin, Barbara Wanjiru Citarella, Emma Hartley, Bastian Lubis, Takanari Ikeyama, Balu Bhaskar, Jae Seung Jung, Shay McGuinness, Glenn M. Eastwood, Sandra Rossi Marta, Fabio Guarracino, Stacy Gerle, Emily Coxon, Bruno Claro, Daniel LoVerde, Namrata Patil, Vieri Parrini, Angela McBride, Kathryn Negaard, Angela Ratsch, Ahmad Abdelaziz, JEFFREY VALENCIA URIBE, Adriano Peris, Mark Sanders, Muhammad Mustafa Kamal, Pedro Póvoa, Roland C. E. Francis, Ali Chérif, Sunimol Joseph, Matteo Di Nardo, Micheal Heard, K. F. KYLE, Ray A. Blackwell, Patrick Biston, Hye Won Jeong, Reanna Smith, Yogi Prawira, Giorgia Montrucchio, Nahikari Salterain-González, Bart Meyns, Marsha Moreno, Rajat Walia, Amit Mehta, Annette Schweda, Moh. 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Rabie, Mok Yee Hui, Masahiro Yamane, Hanna Jung, Ayorinde Mojisola Margaret, Newell Nacpil, Katja Ruck, Rhonda Bakken, Claire Jara, Tim Felton, Lorenzo Berra, Bobby Shah, Arpan Chakraborty, Monika Cardona, Gerry Capatos, Bindu Akkanti, Abiodun Orija, Harsh Jain, Asami Ito, Brahim Housni, Sennen Low, Koji Iihara, Joselito Chavez, Kollengode Ramanathan, Gustavo Zabert, Krubin Naidoo, Ian Seppelt, Marlice VanDyk, Sarah Macdonald, Randy McGregor, Teka Siebenaler, Hannah Flynn, Kristi Lofton, Toshiyuki Aokage, Kazuaki Shigemitsu, Andrea Moscatelli, Giuseppe Fiorentino, Matthias Baumgaertel, Serge Eddy, Jana Assy, Amelya Hutahaean, Holly Roush, Kay A. Sichting, Francesco Alessandri, Debra S. Burns, Gavin Salt, Carl P. Garabedian, Jonathan Millar, Malcolm Sim, Adrian Mattke, Jawad Tadili, Tim Frenzel, Yaron Bar‐Lavie, Aaron Blandino Ortíz, Jackie Stone, Antony Attokaran, Michael Farquharson, Brij Patel, Derek Gunning, J. Kenneth Baillie, Pia Watson, Kenji Tamai, Gede Ketut Sajinadiyasa, Dyah Kanyawati, Marcello Salgado, Assad Sassine, Bhirowo Yudo, Scott McCaul, Bongjin Lee, Sang‐Min Lee, Arnon Afek, Yoshiaki Iwashita, Bambang Pujo Semedi, Jack Metiva, Nicole Van Belle, Ignacio Martín‐Loeches, Lenny Ivatt, Chia Yew Woon, Hyun Mi Kang, T. Jordan Smith, Erskine A. James, Nawar Al‐Rawas, Yudai Iwasaki, Kenny Chan King-Chung, Vadim Gudzenko, Beate Hugi‐Mayr, Fabio Silvio Taccone, Fajar Perdhana, Yoan Lamarche, João Miguel Ribeiro, Nikola Bradić, Klaartje Van den Bossche, Oude Lansink, Gurmeet Singh, Gerdy Debeuckelaere, Henry T. Stelfox, Cassia Yi, Jennifer Elia, Thomas Tribble, Shyam Shankar, Raj Padmanabhan, Bill Hallinan, Luca Paoletti, Yolanda Leyva, Tatuma Fykuda, Jenelle Badulak, Jillian Koch, Amy Hackman, Lisa Janowaik, Deb Hernandez, Jennifer Osofsky, Katia Donadello, Aizah Lawang, Josh Fine, Benjamin Davidson, Andres Oswaldo Razo Vazquez
Bibliographic record
VenueCritical Care · 2022
Typearticle
Languageen
FieldMedicine
TopicRespiratory Support and Mechanisms
Canadian institutionsAlberta Health ServicesInstitut universitaire de cardiologie et de pneumologie de QuébecHamilton General HospitalFoothills Medical CentreSouth Health CampusPrincess Margaret Cancer CentreUniversity of CalgarySt. Boniface HospitalHôpital du Sacré-Cœur de MontréalMcGill University Health CentreLondon Health Sciences CentreRoyal Columbian HospitalUniversité de MontréalMontreal Heart InstituteUniversity of British ColumbiaToronto General HospitalRockyview General HospitalBC Children's HospitalUniversity of Toronto
FundersPrince Charles Hospital FoundationUniversity of QueenslandExtracorporeal Life Support OrganizationUniversità degli Studi di MilanoBill and Melinda Gates FoundationWesley Medical Research“la Caixa” Foundation
KeywordsMedicineARDSPropensity score matchingHazard ratioNeuromuscular Blocking AgentsCohortInternal medicineProportional hazards modelMechanical ventilationCohort studyAnesthesiaConfidence intervalLung
Abstract
BACKGROUND: The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis. METHODS: We analyzed a convenience sample of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2 days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48 h from commencement of IMV were compared with subjects who did not receive NMBAs or only upon commencement of IMV (control). The primary objective in the PS-matched cohort was comparison between groups in 90-day in-hospital mortality, assessed through Cox proportional hazard modeling. Secondary objectives were comparisons in the numbers of ventilator-free days (VFD) between day 1 and day 28 and between day 1 and 90 through competing risk regression. RESULTS: Data from 1953 patients were included. After propensity score matching, 210 cases from each group were well matched. In the PS-matched cohort, mean (± SD) age was 60.3 ± 13.2 years and 296 (70.5%) were male and the most common comorbidities were hypertension (56.9%), obesity (41.1%), and diabetes (30.0%). The unadjusted hazard ratio (HR) for death at 90 days in the NMBA treatment vs control group was 1.12 (95% CI 0.79, 1.59, p = 0.534). After adjustment for smoking habit and critical therapeutic covariates, the HR was 1.07 (95% CI 0.72, 1.61, p = 0.729). At 28 days, VFD were 16 (IQR 0-25) and 25 (IQR 7-26) in the NMBA treatment and control groups, respectively (sub-hazard ratio 0.82, 95% CI 0.67, 1.00, p = 0.055). At 90 days, VFD were 77 (IQR 0-87) and 87 (IQR 0-88) (sub-hazard ratio 0.86 (95% CI 0.69, 1.07; p = 0.177). CONCLUSIONS: In patients with COVID-19 and moderate-to-severe ARDS, short course of NMBA treatment, applied early, did not significantly improve 90-day mortality and VFD. In the absence of definitive data from clinical trials, NMBAs should be indicated cautiously in this setting.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
metaresearch head score (Codex)0.000
metaresearch head score (Gemma)0.000
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Observational · Consensus signal: Observational
GenreCandidate signal: Empirical · Consensus signal: Empirical
Teacher disagreement score0.003
Threshold uncertainty score0.431
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
Opus teacher head0.074
GPT teacher head0.334
Teacher spread0.260 · how far apart the two teachers sit on this one work
Validation status
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
The models applied no category: nothing in the taxonomy fit this work.
Study designObservational
Domainnot available
GenreEmpirical
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".
Quick stats
Citations21
Published2022
Admission routes1
Has abstractyes