Neuromuscular blockade and airway management during endotracheal intubation in Brazilian intensive care units: a national survey

Abstract

Objective To describe the use of neuromuscular blockade as well as other practices among Brazilian physicians in adult intensive care units. Methods An online national survey was designed and administered to Brazilian intensivists. Questions were selected using the Delphi method and assessed physicians’ demographic data, intensive care unit characteristics, practices regarding airway management, use of neuromuscular blockade and sedation during endotracheal intubation in the intensive care unit. As a secondary outcome, we applied a multivariate analysis to evaluate factors associated with the use of neuromuscular blockade. Results Five hundred sixty-five intensivists from all Brazilian regions responded to the questionnaire. The majority of respondents were male (65%), with a mean age of 38 ( 8.4 years, and 58.5% had a board certification in critical care. Only 40.7% of the intensivists reported the use of neuromuscular blockade during all or in more than 75% of endotracheal intubations. In the multivariate analysis, the number of intubations performed monthly and physician specialization in anesthesiology were directly associated with frequent use of neuromuscular blockade. Etomidate and ketamine were more commonly used in the clinical situation of hypotension and shock, while propofol and midazolam were more commonly prescribed in the situation of clinical stability. Conclusion The reported use of neuromuscular blockade was low among intensivists, and sedative drugs were chosen in accordance with patient hemodynamic stability. These results may help the design of future studies regarding airway management in Brazil.

Airway Management in Adult Intensive Care Units: A Survey of Two Regions in China

“…Although ketamine was the first-line recommendation for hemodynamic instability patients during intubation due to its superior hemodynamic effect [ 30 ], a recent prospective randomized single-center study reported that for emergency EI, etomidate was comparable to ketamine in the 28 mortality rate. Nevertheless, propofol and midazolam were the most frequently prescribed as induction agents [ 31 , 32 ], and our investigation revealed a similar outcome, with lower rates of ketamine and etomidate use. This may be attributable to the fact that ketamine is currently unavailable in China, as well as concerns regarding etomidate's adrenal suppression in sepsis patients.…”

Análise comparativa do consumo de sedativos durante o internamento em UTI COVID-19

“…Idade e peso dos pacientes internados em UTI's. (Mendes et al, 2020a). Por outro lado, o uso excessivo de sedativos contribui para o aumento do tempo de internação e de ventilação mecânica (Cardoso & Souza, 2020).…”

“…As orientações do Ministério da Saúde (2020) para manejo de pacientes com COVID-19, recomendam administrar no paciente uma pré-medicação, aguardar 2 minutos e logo em seguida aplicar um sedativo + bloqueador neuromuscular. Como princípio geral, sedativos e agentes bloqueadores neuromusculares devem ser usados o mais moderadamente possível, para minimizar os riscos de delírios, fraqueza adquirida, ventilação mecânica prolongada e dias prolongados no UTI (Mendes et al, 2020a).…”

Endotracheal intubation in COVID-19 patients in Brazil: a nationwide survey

“…Of the physicians, 91% reported the use of neuromuscular blockade during all or more than 75% of endotracheal intubations, which is much higher than previously reported in our survey. ( 2 ) Sedation strategies varied under patient hemodynamic status, and responses did not change with the COVID-19 pandemic.…”

“…In a survey published in Revista Brasileira de Terapia Intensiva before the COVID-19 pandemic, neuromuscular blockade was infrequently used in Brazilian ICUs. ( 2 ) During the COVID-19 pandemic, the fear of staff contamination may have modified usual practice and contributed to increasing the procedure risk. ( 3 , 4 ) Therefore, in this study, we sought to survey ICU physicians about their practices during airway management in COVID-19 patients.…”