• Thomas C Rollinson, Luke A McDonald, Joleen Rose, Glenn Eastwood, Rahul Costa-Pinto, Lucy Modra, Akinori Maeda, Zoe Bacolas, James Anstey, Samantha Bates, Scott Bradley, Jodi Dumbrell, Craig French, Angaj Ghosh, Kimberley Haines, Tim Haydon, Carol L Hodgson, Jennifer Holmes, Nina Leggett, Forbes McGain, Cara Moore, Kathleen Nelson, Jeffrey Presneill, Hannah Rotherham, Simone Said, Meredith Young, Peinan Zhao, Andrew Udy, NetoAry SerpaASDepartment of Intensive Care, Austin Health, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia., Anis Chaba, and Rinaldo Bellomo.
• Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia. Electronic address: thomas.rollinson@austin.org.au.
• J Crit Care. 2024 Feb 1; 79: 154469154469.

PurposeNeuromuscular blockers (NMBs) are often used during prone positioning to facilitate mechanical ventilation in COVID-19 related ARDS. However, their impact on oxygenation is uncertain.MethodsMulti-centre observational study of invasively ventilated COVID-19 ARDS adults treated with prone positioning. We collected data on baseline characteristics, prone positioning, NMB use and patient outcome. We assessed arterial blood gas data during supine and prone positioning and after return to the supine position.ResultsWe studied 548 prone episodes in 220 patients (mean age 54 years, 61% male) of whom 164 (75%) received NMBs. Mean PaO2:FiO2 (P/F ratio) during the first prone episode with NMBs reached 208 ± 63 mmHg compared with 161 ± 66 mmHg without NMBs (Δmean = 47 ± 5 mmHg) for an absolute increase from baseline of 76 ± 56 mmHg versus 55 ± 56 mmHg (padj < 0.001). The mean P/F ratio on return to the supine position was 190 ± 63 mmHg in the NMB group versus 141 ± 64 mmHg in the non-NMB group for an absolute increase from baseline of 59 ± 58 mmHg versus 34 ± 56 mmHg (padj < 0.001).ConclusionDuring prone positioning, NMB is associated with increased oxygenation compared to non-NMB therapy, with a sustained effect on return to the supine position. These findings may help guide the use of NMB during prone positioning in COVID-19 ARDS.Copyright © 2023 Elsevier Inc. All rights reserved.

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