• Marco Daverio, Francesca Sperotto, Chiara Stefani, Maria Cristina Mondardini, Anna Tessari, Paolo Biban, Francesca Izzo, Cinzia Montani, Maria Lapi, Enzo Picconi, Fabrizio Racca, MarinosciGeremia ZitoGZUnit of Pediatric Intensive care, Ospedale Santobono, Napoli, Italy., Fabio Savron, Andrea Wolfler, Angela Amigoni, and Italian Network of PICU Study Group (TIPNet).
• Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital, Padova, Italy.
• Crit. Care Med. 2022 Mar 1; 50 (3): e294e303e294-e303.

ObjectivesWe aim to describe the use of continuous infusion of neuromuscular blocking agents in mechanically ventilated critically ill children and to test its association with in-hospital mortality.DesignMulticenter, registry-based, observational, two-cohort-comparison retrospective study using prospectively collected data from a web-based national registry.SettingSeventeen PICUs in Italy.PatientsWe included children less than 18 years who received mechanical ventilation and a neuromuscular blocking agent infusion from January 2010 to October 2017. A propensity score-weighted Cox regression analysis was used to assess the relationship between the use of neuromuscular blocking agents and in-hospital mortality.InterventionsNone.Measurements And Main ResultsOf the 23,227 patients admitted to the PICUs during the study period, 3,823 patients were included. Patients who received a continuous infusion of neuromuscular blocking agent were more likely to be younger (p < 0.001), ex-premature (p < 0.001), and presenting with less chronic respiratory insufficiency requiring home mechanical ventilation (p < 0.001). Reasons for mechanical ventilation significantly differed between patients who received a continuous infusion of neuromuscular blocking agent and patients who did not receive a continuous infusion of neuromuscular blocking agent, with a higher frequency of respiratory and cardiac diagnosis among patients who received neuromuscular blocking agents compared with other diagnoses (all p < 0.001). The covariates were well balanced in the propensity-weighted cohort. The mortality rate significantly differed among the two cohorts (patients who received a continuous infusion of neuromuscular blocking agent 21% vs patients who did not receive a continuous infusion of neuromuscular blocking agent 11%; p < 0.001 by weighted logistic regression). Patients who received a continuous infusion of neuromuscular blocking agent experienced longer mechanical ventilation and PICU stay (both p < 0.001 by weighted logistic regression). A weighted Cox regression analysis found the use of neuromuscular blocking agents to be a significant predictor of in-hospital mortality both in the unadjusted analysis (hazard ratio, 1.7; 95% CI, 1.3-2.2) and in the adjusted one (hazard ratio, 1.6; 95% CI, 1.2-2.1).ConclusionsThirteen percent of mechanically ventilated children in PICUs received neuromuscular blocking agents. When adjusting for selection bias with a propensity score approach, the use of neuromuscular blocking agent was found to be a significant predictor of in-hospital mortality.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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