Physicians' attitudes and perceptions of neuromuscular blocker infusions in ARDS

Sarah E. Train, Karen E.A. Burns, Brian L. Erstad, Anthony Massaro, Ting Ting Wu, John Vassaur, Kavitha Selvan, John P. Kress, John W. Devlin

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: The perceptions and practices of ICU physicians regarding initiating neuromuscular blocker infusions (NMBI) in acute respiratory distress syndrome (ARDS) may not be evidence-based amidst the surge of severe ARDS during the SARS-CoV-2 pandemic and new practice guidelines. We identified ICU physicians' perspectives and practices regarding NMBI use in adults with moderate-severe ARDS. Materials and methods: After extensive development and testing, an electronic survey was distributed to 342 ICU physicians from three geographically-diverse U.S. health systems(n = 12 hospitals). Results: The 173/342 (50.5%) respondents (75% medical) somewhat/strongly agreed a NMBI should be reserved until: after a trial of deep sedation (142, 82%) or proning (59, 34%) and be dose-titrated based on train-of-four monitoring (107, 62%). Of 14 potential NMBI risks, 2 were frequently reported to be of high/very high concern: prolonged muscle weakness with steroid use (135, 79%) and paralysis awareness due to inadequate sedation (114, 67%). Absence of dyssychrony (93, 56%) and use ≥48 h (87, 53%) were preferred NMBI stopping criteria. COVID-19 + ARDS patients were twice as likely to receive a NMBI (56 ± 37 vs. 28 ± 19%, p < 0.01). Conclusions: Most intensivists agreed NMBI in ARDS should be reserved until after a deep sedation trial. Stopping criteria remain poorly defined. Unique considerations exist regarding the role of paralysis in COVID-19+ ARDS.

Original languageEnglish (US)
Article number154165
JournalJournal of Critical Care
StatePublished - Dec 2022


  • Acute respiratory distress syndrome
  • Coronavirus
  • Intensive care
  • Neuromuscular blockade
  • Survey

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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