Complication profiles of adult asthmatics requiring paralysis during mechanical ventilation

Objective: To assess the characteristics and the incidence of morbidity of intubated asthmatic patients who received long-term paralysis. Design: Retrospective cohort study. Setting: Five intensive care units (ICUs) in Paris and the surrounding suburbs. Patients and participants: The NMB group consisted of patients who received neuromuscular blocking agents for more than 12 h (NMB group) versus sedation alone (SED). Interventions: None. Measurements and results: The incidence of post-extubation muscle weakness and/or myopathy was 18% in the NMB group compared to 2% in the SED group (p=0.01). The occurrence of ventilator-associated pneumonia was higher in the NMB group (42% versus 4%; p<0.0001). The duration of ICU stay and of mechanical ventilation were significantly greater in the NMB group. Multiple logistic regression analysis showed that inclusion in the NMB group was the only independent predictor of the presence of the overall morbidity [odds ratio 6.4 (2.09; 19.64)]. Conclusion: While greater initial severity of respiratory compromise in the NMB group may explain part of the difference, use of NMB agents appears to be strongly related to the presence of significant complications among mechanically-ventilated asthmatic patients.