Association Between Rocuronium Administration and Clinical Outcomes in Patients With Moderate-To-Severe Acute Respiratory Distress Syndrome: A Retrospective Cohort Study

Background: Neuromuscular blocking agents (NMBAs) are commonly used to manage acute respiratory distress syndrome (ARDS). However, the efficacy of continuous NMBA administration other than cisatracurium remains understudied.Objective: To examine the association between continuous rocuronium administration and clinical outcomes in patients with moderate-to-severe ARDS.Methods: A retrospective cohort study was performed using data from a Japanese national inpatient database (April 2018-March 2022). Adult patients with pneumonia requiring mechanical ventilation in the intensive care unit (ICU), with respiratory Sequential Organ Failure Assessment score of >= 3 were included. The patients were divided into those receiving continuous rocuronium (exposure group) and those not receiving any continuous NMBAs (comparison group). The association between continuous rocuronium administration and outcomes was analyzed using multivariable regression analyses fitted with generalized estimating equations.Results: Among 1992 eligible patients, 124 received rocuronium. In-hospital mortality were 30.8% and 25.8% in the comparison and exposure groups, respectively. No significant differences observed in in-hospital mortality (odds ratio [OR] 0.70; 95% confidence interval [CI]: 0.42 to 1.19), ICU mortality (9.0% vs 8.9%, OR 0.87; 95% CI: 0.41 to 1.87), median length of hospital stay (26 vs 28 days, %change 10.5; 95% CI: -8.9 to 34.1), ICU stay (8 vs 10 days, %change 9.0; 95% CI: -4.3 to 24.2), or mechanical ventilation (7 vs 10 days, %change 10.3; 95% CI: -5.3 to 28.5).Conclusion and Relevance: Continuous rocuronium administration for moderate-to-severe ARDS, specifically in patients with pneumonia, was not associated with either improved or worsened clinical outcomes. These findings suggest that rocuronium may be a feasible option as a supportive therapy for ventilator management in patients with moderate-to-severe ARDS, providing a basis for further research in clinical settings.