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Background <p>Neuromuscular blocking agents (NMBA) have been used in mechanically ventilated patients with moderate-to-severe acute respiratory distress syndrome (ARDS), in cases of clinically significant ventilator dyssynchrony, and in patients with elevated intracranial pressure (ICP). However, practice patterns around NMBA utilization and their impact on outcomes in acute brain injury (ABI) remain insufficiently explored.</p> Methods <p>This study carried out a post&#xa0;hoc analysis of a multicenter, prospective observational study (NCT03400904) including adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required invasive mechanical ventilation (IMV) ≥ 24 h. Patients who received NMBA during their first week of ICU stay were propensity matched to those who did not.</p> Results <p>Propensity score matching was performed in 1482 patients; among the matched cohort (<i>n</i> = 258), 33.3% (<i>n</i> = 86) received NMBA. NMBA utilization varied from 0% to 59.3% across countries. Multivariable regressions demonstrated associations between NMBA use and utilization of intraparenchymal ICP monitoring (odds ratio, OR 2.06; 95% confidence interval, CI 1.16–3.76), extraventricular drain placement (OR 2.18; 95% CI 1.18–4.05), higher PaCO<sub>2</sub> values (OR 1.04; 95% CI 1.01–1.09), and moderate-to-severe ARDS (OR 2.40; 95% CI 1.16–5.05). NMBA use was associated with lower hospital mortality (OR 0.35; 95% CI 0.11–0.99) and prolonged IMV duration (OR 1.56; 95% CI 1.38–1.76), but not with reintubation rates or tracheostomy placement.</p> Conclusions <p>NMBA utilization varied widely, highlighting the need for more evidence to guide clinical practice. NMBA were most commonly used in patients with ICP monitoring or moderate-to-severe ARDS; associations with outcomes warrant further exploration in randomized controlled trials.</p>

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Utilization of Neuromuscular Blocking Agents in Acute Brain Injury and Associations with Outcomes: A Post Hoc Analysis of the ENIO Study

  • 期刊论文

  • 发表日期：

    2026年3月6日

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  • Andrea Berardino,
  • Fabio Gallo,
  • Denise Battaglini,
  • Raphael Cinotti,
  • Karim Asehnoune,
  • Patricia R. M. Rocco,
  • Fabio Silvio Taccone,
  • Nicolo’ Patroniti,
  • Marcus J. Schultz,
  • Andrea Barbanera,
  • Alessandro Bertuccio,
  • Luca Montagnani,
  • Pietro Fiaschi,
  • Gianluigi Zona,
  • Sarah Wahlster,
  • Chiara Robba,
  • Paër-sélim Abback,
  • Anaïs Codorniu,
  • Giuseppe Citerio,
  • Vittoria Ludovica Sala,
  • Marinella Astuto,
  • Eleonora Tringali,
  • Daniela Alampi,
  • Monica Rocco,
  • Jessica Giuseppina Maugeri,
  • Agrippino Bellissima,
  • Matteo Filippini,
  • Nicoletta Lazzeri,
  • Andrea Cortegiani,
  • Mariachiara Ippolito,
  • Chiara Robba,
  • Denise Battaglini,
  • Patrick Biston,
  • Mohamed Fathi Al-Gharyani,
  • Russell Chabanne,
  • Léo Astier,
  • Benjamin Soyer,
  • Samuel Gaugain,
  • Alice Zimmerli,
  • Urs Pietsch,
  • Miodrag Filipovic,
  • Giovanna Brandi,
  • Giulio Bicciato,
  • Ainhoa Serrano,
  • Berta Monleon,
  • Peter van Vliet,
  • Benjamin Marcel Gerretsen,
  • Iris Xochitl Ortiz-Macias,
  • Jun Oto,
  • Noriya Enomoto,
  • Tomomichi Matsuda,
  • Nobutaka Masui,
  • Pierre Garçon,
  • Jonathan Zarka,
  • Wytze J. Vermeijden,
  • Alexander Daniel Cornet,
  • Sergio Reyes Inurrigarro,
  • Rafael Cirino Lara Domínguez,
  • Maria Mercedes Bellini,
  • Maria Milagros Gomez Haedo,
  • Laura Lamot,
  • Jose Orquera,
  • Matthieu Biais,
  • Delphine Georges,
  • Arvind Baronia,
  • Roberto Carlos Miranda-Ackerman,
  • Francisco José Barbosa-Camacho,
  • John Porter,
  • Miguel Lopez-Morales,
  • Thomas Geeraerts,
  • Baptiste Compagnon,
  • David Pérez-Torres,
  • Estefanía Prol-Silva,
  • Hana Basheer Yahya,
  • Ala Khaled,
  • Mohamed Ghula,
  • Cracchiolo Neville Andrea,
  • Palma Maria Daniela,
  • Cristian Deana,
  • Luigi Vetrugno,
  • Manuel J. Rivera Chavez,
  • Rocio Mendoza Trujillo,
  • Vincent Legros,
  • Benjamin Brochet,
  • Olivier Huet,
  • Marie Geslain,
  • Mathieu van der Jagt,
  • Job van Steenkiste,
  • Hazem Ahmed,
  • Alexander Edward Coombs,
  • Jessie Welbourne,
  • Ana Alicia Velarde Pineda,
  • Víctor Hugo Nubert Castillo,
  • Mohammed A. Azab,
  • Ahmed Azzam,
  • David Michael Paul van Meenen,
  • Gilberto Adrian Gasca,
  • Alfredo Arellano,
  • Forttino Galicia-Espinosa,
  • José Carlos García-Ramos,
  • Ghanshyam Yadav,
  • Amarendra Kumar Jha,
  • Vincent Robert-Edan,
  • Pierre-Andre Rodie-Talbere,
  • Gaurav Jain,
  • Sagarika Panda,
  • Sonika Agarwal,
  • Yashbir Deewan,
  • Gilberto Adrian Gasca,
  • Alfredo Arellano,
  • Syed Tariq Reza,
  • Md. Mozaffer Hossain,
  • Christos Papadas,
  • Vasiliki Chantziara,
  • Chrysanthi Sklavou,
  • Yannick Hourmant,
  • Nicolas Grillot,
  • Job van Steenkiste,
  • Mathieu van der Jagt,
  • Romain Pirracchio,
  • Abdelraouf Akkari,
  • Mohamed Abdelaty,
  • Ahmed Hashim,
  • Yoann Launey,
  • Elodie Masseret,
  • Sigismond Lasocki,
  • Soizic Gergaud,
  • Nicolas Mouclier,
  • Sulekha Saxena,
  • Avinash Agrawal,
  • Shakti Bedanta Mishra,
  • Samir Samal,
  • Julio Cesar Mijangos,
  • Mattias Haënggi,
  • Mohan Gurjar,
  • Marcus J. Schultz,
  • Callum Kaye,
  • Daniela Agustin Godoy,
  • Pablo Alvarez,
  • Aikaterini Ioakeimidou,
  • Yoshitoyo Ueno,
  • Rafael Badenes,
  • Abdurrahmaan Ali Suei Elbuzidi,
  • Michaël Piagnerelli,
  • Muhammed Elhadi,
  • Syed Tariq Reza,
  • Mohammed Atef Aza,
  • Jean Catherine Digitale,
  • Nicholas Fong,
  • Ricardo Campos Cerda,
  • Norma de la Torre Peredo

摘要

Background

Neuromuscular blocking agents (NMBA) have been used in mechanically ventilated patients with moderate-to-severe acute respiratory distress syndrome (ARDS), in cases of clinically significant ventilator dyssynchrony, and in patients with elevated intracranial pressure (ICP). However, practice patterns around NMBA utilization and their impact on outcomes in acute brain injury (ABI) remain insufficiently explored.

Methods

This study carried out a post hoc analysis of a multicenter, prospective observational study (NCT03400904) including adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required invasive mechanical ventilation (IMV) ≥ 24 h. Patients who received NMBA during their first week of ICU stay were propensity matched to those who did not.

Results

Propensity score matching was performed in 1482 patients; among the matched cohort (n = 258), 33.3% (n = 86) received NMBA. NMBA utilization varied from 0% to 59.3% across countries. Multivariable regressions demonstrated associations between NMBA use and utilization of intraparenchymal ICP monitoring (odds ratio, OR 2.06; 95% confidence interval, CI 1.16–3.76), extraventricular drain placement (OR 2.18; 95% CI 1.18–4.05), higher PaCO2 values (OR 1.04; 95% CI 1.01–1.09), and moderate-to-severe ARDS (OR 2.40; 95% CI 1.16–5.05). NMBA use was associated with lower hospital mortality (OR 0.35; 95% CI 0.11–0.99) and prolonged IMV duration (OR 1.56; 95% CI 1.38–1.76), but not with reintubation rates or tracheostomy placement.

Conclusions

NMBA utilization varied widely, highlighting the need for more evidence to guide clinical practice. NMBA were most commonly used in patients with ICP monitoring or moderate-to-severe ARDS; associations with outcomes warrant further exploration in randomized controlled trials.