title: Perceived safety and efficacy of neuromuscular blockers for acute respiratory distress syndrome among medical intensive care unit practitioners: A multicenter survey.
abstract: Neuromuscular blocking agents (NMBAs) are frequently used in patients with acute respiratory distress syndrome (ARDS). The purpose of this survey is to describe providers' knowledge and perceived efficacy and safety of NMBAs in patients with ARDS.
  
  
  
  We performed a prospective, multicenter survey of medical intensive care unit intensivists, fellows, nurse practitioners (NPs), physician's assistants (PAs), and pharmacists at 5 tertiary care centers between July 2012 and May 2013.
  
  
  
  A total of 335 surveys were sent to providers, with a 47% response rate. Ninety-eight percent of providers correctly identified that NMBAs lack anxiolytic and analgesic properties. The effect of end-organ damage on NMBA clearance was less commonly identified by NPs/PAs for both hepatic (P=.0077) and renal (P=.0272) dysfunction compared with physicians. More NP/PAs identified the association of consciousness with the use of NMBAs than physicians (P=.047). Forty-two percent of prescribers reported always or frequently using continuous-infusion NMBAs in patients with severe ARDS, with 89% initiating NMBAs because of ventilator dyssynchrony. Prescribers perceived continuous NMBAs to be more effective than inhaled prostaglandins (74% vs 56%) in severe ARDS but less safe (45% vs 84%). Train of 4 was identified by 54% of prescribers as their primary method for titration.
  
  
  
  Providers are knowledgeable about NMBAs, but educational opportunities exist. Perceptions about the efficacy and safety of NMBAs varied among prescribers, and inconsistencies existed in the prioritization of management strategies for ARDS.
authors.affiliation: Department of Pharmacy, Cleveland Clinic, 9500 Euclid Ave, Hb-105, Cleveland, OH 44195. Electronic address: torbich@ccf.org.
authors.forename: Heather
authors.initials: H
authors.lastname: Torbic
authors.affiliation: Department of Pharmacy, Cleveland Clinic, 9500 Euclid Ave, Hb-105, Cleveland, OH 44195.
authors.forename: Seth R
authors.initials: SR
authors.lastname: Bauer
authors.affiliation: Department of Pharmacy, Mayo Clinic, 200 1st St SW, Rochester, MN 55901.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Personett
authors.affiliation: Department of Pharmacy, New York Presbyterian Hospital, 612 W 168th St, New York, NY 10032.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Dzierba
authors.affiliation: Department of Pharmaceutical Services, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Stollings
authors.affiliation: Department of Pharmacy, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210.
authors.forename: Lindsay P
authors.initials: LP
authors.lastname: Ryder
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55901.
authors.forename: Craig E
authors.initials: CE
authors.lastname: Daniels
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55901.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Caples
authors.affiliation: Department of Pharmacy, Mayo Clinic, 200 1st St SW, Rochester, MN 55901.
authors.forename: Erin N
authors.initials: EN
authors.lastname: Frazee
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003422:Critical Care; D003430:Cross-Sectional Studies; D006801:Humans; D007362:Intensive Care Units; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects / Q000627:therapeutic use*; D009722:Nurse Practitioners; D010595:Pharmacists; D010823:Physician Assistants; D010820:Physicians; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012449:Safety; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers
chemical_list: D009466:Neuromuscular Blocking Agents
keywords: Acute respiratory distress syndrome; Neuromuscular blocking agent; Pharmacist; Prescriber; Survey