• Sangeeta Mehta, Qi Zhou, Ruxandra Pinto, Jan O Friedrich, François Lamontagne, Niall D Ferguson, Maureen O Meade, AdhikariNeill K JNKJDepartment of Critical Care Medicine, Sunnybrook Health Sciences Centre and Interdepartmental Division of Critical Care Medicine and Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada., and OSCILLATE Investigators and the Canadian Critical Care Trials Group.
• Department of Medicine, Sinai Health, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. Electronic address: geeta.mehta@utoronto.ca.
• J Crit Care. 2021 Dec 1; 66: 86-92.

PurposeWe evaluated characteristics associated with neuromuscular blockade (NMB) use, center-level variation, and whether NMB mediated excess mortality among patients assigned to high-frequency oscillatory ventilation (HFOV) in the OSCILLATE trial.Materials And MethodsNMB exposure was defined as receipt after randomization; the primary outcome was hospital mortality. Descriptive analyses compared NMB-exposed vs unexposed patients. Multivariable analyses included patients not on baseline NMB. Cox regression evaluated associations of patient- and center-level variables with NMB use. A log-normal frailty model evaluated center effects. Mediation analysis examined the effect of NMB in HFOV-assigned patients.Results376/548 patients (39 centers) received post-randomization NMB, of whom 165 received baseline NMB. Patients receiving post-randomization NMB (vs. not) had worse lung mechanics and gas exchange, received more sedation and vasopressors (p < 0.05), and had higher hospital mortality (44% vs. 34%, p = 0.03). Mean airway pressure ≥ 24 cmH2O, randomization to HFOV, and intensive care unit size ≥ 31 beds were associated with post-randomization NMB. After adjustment, center had a negligible effect on post-randomization NMB (median hazard ratio 1.01, p = 0.047). NMB use did not mediate excess mortality among HFOV-allocated patients (p = 0.80).ConclusionsIn OSCILLATE, receipt of post-randomization NMB was associated with worse outcomes, but NMB use did not mediate HFOV-associated higher mortality.Copyright © 2021 Elsevier Inc. All rights reserved.

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