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Abstract

Introduction: Critical care provider knowledge and perceptions of neuromuscular blocking agents (NMBA) may be insufficient to adopt the recent evidence supporting their use for select patients with acute respiratory distress syndrome (ARDS). Hypothesis: There is suboptimal knowledge and variable use of NMBA for ARDS among ICU providers. Methods: This prospective, single-center survey study was administered in two medical ICUs at Mayo Clinic. The 15-question survey was designed with the Mayo Clinic Survey Research Center and validated in 20 non-included ICU practitioners. For a two-sided alpha of 0.05, 150 providers were necessary to have 8% precision for a dichotomous response. Results: Survey response rate was 53% (166 of 314), including 40 prescribers (intensivists, critical care fellows, nurse practitioners, physician’s assistants), 112 non-prescribers (pharmacists, nurses, respiratory therapists) and 14 unknown respondents. Most respondents correctly identified NMBA as non-analgesic (94%) and non-anxiolytic (89%). Muscle breakdown, foot drop, and corneal abrasion were the most frequently recognized adverse effects of NMBA, whereas consciousness and thromboembolism were infrequently noted (25% and 45%, respectively). Among the prescribers, 50% correctly identified the hepatic clearance of vecuronium, whereas 28% incorrectly identified atracurium as renally eliminated. In all respondents, 9% reported frequent use of continuous infusion NMBA (CI-NMBA) in all-comers with ARDS and 47% in severe ARDS. The prescriber subgroup was similar (5% and 51%, respectively). Pharmacists least often advocated for use of CI-NMBA in severe ARDS (11%). The majority of respondents felt CI-NMBA to be at least somewhat safe and effective (65% and 79%, respectively) for ARDS. Prescribers felt similarly about the efficacy of CI-NMBA for ARDS (72% report they are at least somewhat effective), yet fewer felt they were at least somewhat safe (51%). Conclusions: Provider knowledge of NMBA therapeutics and adverse effects may be insufficient to implement practice change. As evidence of such, frequent use of CI-NMBA, even in severe ARDS, was supported by <50% of providers despite reporting these agents to be somewhat safe and effective.