Application of Neuromuscular Blockers in Patients with ARDS in ICU: A Retrospective Study Based on the MIMIC-III Database

Background: Although neuromuscular blocker agents (NMBAs) are recommended by guidelines as a treatment for ARDS patients, the efficacy of NMBAs is still controversial. Our study aimed to investigate the association between cisatracurium infusion and the medium- and long-term outcomes of critically ill patients with moderate and severe ARDS. Methods: We performed a single-center, retrospective study of 485 critically ill adult patients with ARDS based on the Medical Information Mart for Intensive Care III (MIMIC-III) database. Propensity score matching (PSM) was used to match patients receiving NMBA administration with those not receiving NMBAs. The Cox proportional hazards model, Kaplan-Meier method, and subgroup analysis were used to evaluate the relationship between NMBA therapy and 28-day mortality. Results: A total of 485 moderate and severe patients with ARDS were reviewed and 86 pairs of patients were matched after PSM. NMBAs were not associated with reduced 28-day mortality (hazard ratio (HR) 1.44; 95% CI: 0.85 similar to 2.46; p = 0.20), 90-day mortality (HR = 1.49; 95% CI: 0.92 similar to 2.41; p = 0.10), 1-year mortality (HR = 1.34; 95% CI: 0.86 similar to 2.09; p = 0.20), or hospital mortality (HR = 1.34; 95% CI: 0.81 similar to 2.24; p = 0.30). However, NMBAs were associated with a prolonged duration of ventilation and the length of ICU stay. Conclusions: NMBAs were not associated with improved medium- and long-term survival and may result in some adverse clinical outcomes.