Physicians' attitudes and perceptions of neuromuscular blocker infusions in ARDS

Critical Care Pharmacist Attitudes and Perceptions of Neuromuscular Blocker Infusions in ARDS

“…13 Strengths of the current study include use of a rigorously designed and administered questionnaire, a favorable response rate, 16 geographically diverse respondents that worked in both medical and surgical ICUs, and comparison to ICU physician perceptions evaluated using a similar questionnaire. 14 Our study also has limitations. Although our response rate was higher than most prior electronic surveys of pharmacists and our respondents were geographically diverse, it is unclear whether our respondent cohort reflects the current case-mix and distribution of CCPs across the United States, particularly as COVID-19 surges have varied substantially between regions.…”

“…We adapted the pharmacist questionnaire from a rigorously developed and validated questionnaire administered in 2021 to 342 ICU physicians from 3 geographically diverse health systems (n = 12 hospitals). 14 In developing and testing the physician questionnaire we previously conducted item generation (through an extensive literature review), item reduction/clarification (questionnaire review by 8 international experts in ARDS/NMBI use), and sensibility testing (questionnaire review by 6 U.S. ICU attending physicians). 14,16 In the physician questionnaire we focused on NMBI use in SARS-CoV-2 positive or negative adults with moderate to severe ARDS (PaO 2 : FiO 2 <150 mmHg) and critical hypoxemia and/or hypercapnia (where causes of patient- and ventilator-associated dyssynchrony had been addressed and PEEP was optimized).…”

“…Subsequently, we compared results from this pharmacist survey to those in the physician survey. 14 Responses were analyzed using standard statistics, including the χ 2 test and Student t test, for binary and continuous variables, respectively. A p-value of ≤0.05 was considered statistically significant.…”

“…Reasons for NMBI initiation did not differ between pharmacists who worked in a medical (vs non-medical) ICU (Supplementary Table 2). Compared to the prior physician survey, 14 a greater proportion of pharmacists (vs. physicians) somewhat/strongly agreed a trial of proning should occur before NMBI initiation (70.2 vs. 33.9%, P < 0.01) and a smaller proportion agreed NMBI initiation would ensure patient-ventilator synchrony (66.4 vs. 85.6%, P < 0.01) or oxygenation (34.8 vs. 57.5%, P < 0.02) (Supplementary Table 3).…”

“…In the face of controversy regarding role for NMBI use in ARDS and increased NMBI use during the current SARS-CoV-2 pandemic, the perceptions and practices of ICU clinicians regarding NMBI use in critically ill adults with moderate to severe ARDS are important to identify. Although the practices and perceptions of U.S. ICU physicians regarding NMBI use in ARDS has recently been evaluated, 14 the perspective of critical care pharmacists (CCPs), has not been evaluated since 2017 15 despite their frequent involvement in NMBI prescribing decisions in the ICU and the ARDS patient surges and sedative shortages they helped manage during the SARS-CoV-2 pandemic. We therefore designed (developed, tested, and administered) a survey to determine CCPs’ attitudes and perceptions regarding NMBI use in adults with moderate to severe ARDS from both SARS-CoV-2 and non-SARS-CoV-2 and compared them to those of ICU physicians.…”