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Clinical Investigations in Critical Care |

Use of Sedatives and Neuromuscular Blockers in a Cohort of Patients Receiving Mechanical Ventilation*

Alejandro Arroliga, MD, FCCP; Fernando Frutos-Vivar, MD; Jesse Hall, MD; Andres Esteban, MD; Carlos Apezteguía, MD; Luis Soto, MD; Antonio Anzueto, MD; for the International Mechanical Ventilation Study Group
Author and Funding Information

Affiliations: *From the Cleveland Clinic Foundation (Dr. Arroliga), Cleveland, OH; Hospital Universitario de Getafe (Drs. Frutos-Vivar and Esteban), Spain; University of Chicago (Dr. Hall), Chicago, IL; Hospital Profesor Posadas (Dr. Apezteguía), Buenos Aires, Argentina; University of Texas Health Science Center at San Antonio (Dr. Anzueto) and Instituto Nacional del Tórax (Dr. Soto), Santiago, Chile.,  For members of the Mechanical Ventilation Study Group, see the Appendix.

Correspondence to: Antonio Anzueto MD, University of Texas Health Science Center at San Antonio, 111E, 7400 Merton Minter Blvd, San Antonio, TX 78229; e-mail: anzueto@uthscsa.edu



Chest. 2005;128(2):496-506. doi:10.1378/chest.128.2.496
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Objective: To describe the use of sedatives and neuromuscular blocking agents (NMBs) and their impact in outcome in an international cohort of patients receiving mechanical ventilation.

Methods: We analyzed the database of a prospective, multicenter cohort of 5,183 adult patients who received mechanical ventilation for > 12 h. We considered that a patient received a given agent when it was administered for at least 3 h in a 24-h period.

Results: A total of 3,540 patients (68%; 95% confidence interval [CI], 67 to 69%) received a sedative at any time while receiving mechanical ventilation. The median number of days of use was 3 (interquartile range [IQR], 2 to 6 days). The persistent use of sedative was associated with more days of mechanical ventilation (median, 4 days [IQR, 2 to 8 days], vs 3 days [IQR, 2 to 4 days] in patients who did not receive sedatives [p < 0.001]); more weaning days (median, 2 days [IQR, 1 to 3 days], vs 2 days [IQR, 1 to 5 days] in patients who did not receive sedatives [p < 0.001]); and longer length of stay in the ICU (median, 8 days [IQR, 5 to 15 days], vs 5 days [IQR, 3 to 9 days] in patients who did not receive sedatives [p < 0.001]). Six hundred eighty-six patients (13%; 95% CI, 12 to 14%) received an NMB for at least 1 day. The median number of days of use was 2 (IQR, 1 to 4 days). The administration of an NMB was independently related with age, a normal previous functional status, main reason of mechanical ventilation (patients with ARDS received more NMBs), and with patient management (patients requiring permissive hypercapnia, prone position, high level of positive end-expiratory pressure, and high airways pressure).

Conclusions: The use of sedatives is very common, and their use is associated with a longer duration of mechanical ventilation, weaning time, and stay in the ICU. NMBs are used in 13% of the patients and are associated with longer duration of mechanical ventilation, weaning time, stay in the ICU, and higher mortality.

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