Evidence from a Bayesian reanalysis of the iPROVE-OLV study: is it time to update our prior assumptions regarding neuromuscular block and reversal?

Abstract

In a Bayesian secondary analysis of a subset of 698 patients in the iPROVE-OLV study, Mazzinari and colleagues report evidence of benefit for the use of neuromuscular monitoring and reversal under a range of prior assumptions (i.e. assumptions of probability of benefit or harm). This is a secondary analysis of the iPROVE-OLV study, a 1308-patient RCT of individualised PEEP and postoperative high-flow nasal cannula oxygen in patients undergoing thoracic surgery. However, detailed information on monitoring modalities and reversal agent dosage, which could impact practice, were not available for analysis. Recent practice guidelines, published by both European and American professional societies have supported routine use of quantitative neuromuscular block and reversal. Practice surveys and observational analyses that predate these guidelines suggest that a significant gap between real world and guideline-recommended practice exists.