Are nondepolarizing neuromuscular blocking agents truly a risk factor for late-onset ventilator-associated pneumonia?

Excerpt

Sir: We were surprised by the recent contribution by Leone et al. in Intensive Care Medicine in which they report risk factors for late-onset ventilator associated pneumonia (VAP) in trauma patients [1]. They show that the use of nondepolarizing neuromuscular blocking agents is linked with a 3.4-fold increase in the occurrence of VAP, while depolarizing neuromuscular blocking agents tend to be associated with a protective effect. The authors must have been surprised, too. They hypothesized that use of neuromuscular blocking agents per se affects the incidence of pneumonia and not the type of neuromuscular blocking agent. We believe that one should be careful in drawing conclusions from unexpected results; it may very well be that other, yet undefined factors play a confounding role. Unfortunately, the authors did not try to unravel this in their report. …