Utilization of Neuromuscular Blocking Agents in Acute Brain Injury and Associations with Outcomes: A Post Hoc Analysis of the ENIO Study
Issued Date
2026-01-01
Resource Type
ISSN
15416933
eISSN
15560961
Scopus ID
2-s2.0-105034023906
Pubmed ID
41792523
Journal Title
Neurocritical Care
Rights Holder(s)
SCOPUS
Bibliographic Citation
Neurocritical Care (2026)
Suggested Citation
Berardino A., Gallo F., Battaglini D., Cinotti R., Asehnoune K., Rocco P.R.M., Taccone F.S., Patroniti N., Schultz M.J., Barbanera A., Bertuccio A., Montagnani L., Fiaschi P., Zona G., Wahlster S., Robba C. Utilization of Neuromuscular Blocking Agents in Acute Brain Injury and Associations with Outcomes: A Post Hoc Analysis of the ENIO Study. Neurocritical Care (2026). doi:10.1007/s12028-026-02473-8 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/115990
Title
Utilization of Neuromuscular Blocking Agents in Acute Brain Injury and Associations with Outcomes: A Post Hoc Analysis of the ENIO Study
Author's Affiliation
University of Washington
Universidade Federal do Rio de Janeiro
Università degli Studi di Genova
Medizinische Universität Wien
Nantes Université
IRCCS San Martino Polyclinic Hospital
Nuffield Department of Medicine
CHU de Nantes
Mahidol Oxford Tropical Medicine Research Unit
Hôpital Universitaire de Bruxelles (HUB)
Hospital of St. Gallen
AOU Santi Antonio e Biagio
Universidade Federal do Rio de Janeiro
Università degli Studi di Genova
Medizinische Universität Wien
Nantes Université
IRCCS San Martino Polyclinic Hospital
Nuffield Department of Medicine
CHU de Nantes
Mahidol Oxford Tropical Medicine Research Unit
Hôpital Universitaire de Bruxelles (HUB)
Hospital of St. Gallen
AOU Santi Antonio e Biagio
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Neuromuscular blocking agents (NMBA) have been used in mechanically ventilated patients with moderate-to-severe acute respiratory distress syndrome (ARDS), in cases of clinically significant ventilator dyssynchrony, and in patients with elevated intracranial pressure (ICP). However, practice patterns around NMBA utilization and their impact on outcomes in acute brain injury (ABI) remain insufficiently explored. Methods: This study carried out a post hoc analysis of a multicenter, prospective observational study (NCT03400904) including adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required invasive mechanical ventilation (IMV) ≥ 24 h. Patients who received NMBA during their first week of ICU stay were propensity matched to those who did not. Results: Propensity score matching was performed in 1482 patients; among the matched cohort (n = 258), 33.3% (n = 86) received NMBA. NMBA utilization varied from 0% to 59.3% across countries. Multivariable regressions demonstrated associations between NMBA use and utilization of intraparenchymal ICP monitoring (odds ratio, OR 2.06; 95% confidence interval, CI 1.16–3.76), extraventricular drain placement (OR 2.18; 95% CI 1.18–4.05), higher PaCO<inf>2</inf> values (OR 1.04; 95% CI 1.01–1.09), and moderate-to-severe ARDS (OR 2.40; 95% CI 1.16–5.05). NMBA use was associated with lower hospital mortality (OR 0.35; 95% CI 0.11–0.99) and prolonged IMV duration (OR 1.56; 95% CI 1.38–1.76), but not with reintubation rates or tracheostomy placement. Conclusions: NMBA utilization varied widely, highlighting the need for more evidence to guide clinical practice. NMBA were most commonly used in patients with ICP monitoring or moderate-to-severe ARDS; associations with outcomes warrant further exploration in randomized controlled trials.