Elastance May Determine the Neuromuscular Blockade Effect on Mortality in Acute Respiratory Distress Syndrome

作者：Ann A. Zalucky, José Dianti, Lucile Neyton, Pratik Sinha, Kathleen D. Liu, Michael A. Matthay, Bruce Thompson, Ewan C. Goligher, Carolyn S. Calfee · 发表于：American Journal of Respiratory and Critical Care Medicine · 年份：2025 · DOI：10.1164/rccm.202406-1231oc · 被引用次数：27 · 研究领域：Respiratory Support and Mechanisms、Intensive Care Unit Cognitive Disorders、Anesthesia and Neurotoxicity Research

Abstract Rationale Patients with acute respiratory distress syndrome (ARDS) have a reduction in functional lung volume that results in increased respiratory system elastance (Ers); however, the extent of this increase varies by patient. Patients with high Ers are at risk of excess lung-distending pressures and may derive greater clinical benefit from neuromuscular blockade (NMB). Objectives We sought to evaluate whether the effect of early NMB administration on mortality varies according to baseline physiological and biological biomarkers of lung injury, including Ers. Methods We conducted a secondary analysis of the Reevaluation of Systemic Early Neuromuscular Blockade, or ROSE, trial. Bayesian logistic regression modeling was used to estimate the posterior probability of NMB effect moderation by baseline Ers, ventilatory ratio, and select ARDS plasma biomarkers on 90-day mortality. Measurements and Main Results The probability of mortality benefit with NMB increased substantially with higher baseline Ers (posterior probability of interaction, 92%; interaction odds ratio = 0.76; 90% credible interval = 0.59–0.99). In patients with an Ers ⩾2 cm H2O/(ml/kg), the posterior probability of benefit was 96% (median absolute risk reduction, 9%; 90% credible interval = 0.5–17.9). The effect of NMB did not vary meaningfully according to ventilatory ratio (posterior probability of interaction, 62%) or baseline plasma levels of receptor for advanced glycation end-products, tumor necrosi...