ICU Patients

Reversibly paralyzing and heavily sedating hospitalized ICU Patients with severe breathing problems do not improve outcomes in most cases, according to a National Institutes of Health-sponsor clinical trial conduct at dozens of North American hospitals and led by clinician scientists at the University of Pittsburgh and University of Colorado schools of medicine.

Short term paralysis

It’s been a conundrum on the one hand, really well done studies have show that temporarily paralyzing; so the patient to improve mechanical breathing saves lives. But you can’t paralyze without heavy sedation; also studies also show heavy sedation results in worse recovery. You can’t have both so what’s a clinician to do?” said senior author Derek Angus, M.D., M.P.H., who holds the Mitchell P. Fink Endowed Chair of the Pitt School of Medicine’s Department of Critical Care Medicine.

Our trial finally settles it light sedation with intermittent; so short term paralysis if necessary is as good as deep sedation with continuous paralysis. From January 2016 through April 2018, 1,006 patients at 48 U.S. and Canadian hospitals were enrol in ROSE within hours; hence after onset of moderate to severe acute respiratory distress syndrome.

Half were given a 48-hour continuous neuro muscular blockade a medication; so that paralyzes them along with heavy sedation because it is traumatizing to be paralyze while conscious. The other half were given light sedation; also the clinician had the option of giving a small dose of neuro muscular blockade; so that would wear off in under an hour to ease respiratory intubation.

The mechanical ventilation

The trial was need because a French trial find in 2010 that neuro muscular blockade reduce mortality. However, in that trial all participants were heavily sedate; so regardless of whether they receive the neuro muscular blockade or not. In recent years, particularly in North America, clinicians have trend away from heavy sedation, which is associate with cardiovascular complications, delirium and increase difficulty weaning patients from mechanical ventilation.

In the ROSE trial, the patients who receive the neuromuscular blockade; also sedation develop more cardiovascular issues while in the hospital; but there were no significant differences in mortality between the two groups three, six or 12 months later, said David Huang, M.D., M.P.H., who oversaw clinical implementation of the trial and is an associate professor of critical care and emergency medicine at Pitt’s School of Medicine.

Angus, who also directs Pitt’s Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, said the trial results make him confident when he says that avoiding paralysis and deep sedation is the best practice for most patients hospitalize with breathing problems. However, he notes that future trials will be need to tease out whether there is a subpopulation of patients with acute respiratory distress syndrome who still benefit from neuromuscular blockade.