Comparison of fixed dose versus train-of-four titration of cisatracurium in acute respiratory distress syndrome.

Journal of Critical Care
Melissa L Thompson BastinAlexander H Flannery

Abstract

To compare the ventilatory and clinical outcomes associated with a fixed-dose cisatracurium infusion versus a titrated infusion strategy in patients with Acute Respiratory Distress Syndrome (ARDS). Single-center, retrospective, cohort study in a medical ICU of a tertiary care academic medical center. Adult patients ≥18 years old with a continuous infusion of cisatracurium for ≥12 h for treatment of ARDS were included. The primary outcome was the PaO2 /FiO2 ratio assessed at 24 and 48 h following cisatracurium initiation. Secondary outcomes included amount of average dose of drug administered, 28-day ventilator-free days, LOS, and hospital mortality. 167 patients were included; median baseline PaO2/FiO2 was 97 (76-146), median SOFA score of 9 (7-11), and ICU mortality was 71/167 (43%). In a mixed-effects model, fixed dose and titrated cisatracurium associated with similar changes in PaO2/FiO2 assessed at 24 and 48 h (p = 0.316). Fixed-dose was associated with a >3-fold increase in drug exposure (average dose 6.4 (5.4-8.0) vs. 2.0 (1.5-2.8) mcg/kg/min; p < 0.001, respectively). No differences were observed in secondary clinical endpoints. Fixed-dose cisatracurium was associated with similar ventilatory and clinical outcomes compa...Continue Reading

References

Feb 7, 1998·Medical Care·A ElixhauserR M Coffey
Jun 19, 2007·Chest·Todd W RiceUNKNOWN National Institutes of Health, National Heart, Lung, and Blood Institute ARDS Network
Sep 17, 2010·The New England Journal of Medicine·Laurent PapazianUNKNOWN ACURASYS Study Investigators
Jan 20, 2015·Critical Care Medicine·Colin K GrissomUNKNOWN National Heart Lung and Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network
Oct 19, 2016·Critical Care Medicine·Michael J MurraySangeeta Mehta
Oct 26, 2016·Annals of the American Thoracic Society·David T HuangUNKNOWN Reevaluation of Systemic Early Neuromuscular Blockade Protocol Committee and the National Institutes of Health National Hear
Aug 5, 2017·Annals of Intensive Care·Sami HraiechJérémy Bourenne
May 7, 2019·Seminars in Respiratory and Critical Care Medicine·John P ReillyJason D Christie
May 22, 2019·The New England Journal of Medicine·UNKNOWN National Heart, Lung, and Blood Institute PETAL Clinical Trials NetworkDerek C Angus
Jun 15, 2019·Annals of Intensive Care·Laurent PapazianHenri Faure
Mar 1, 2020·The Annals of Pharmacotherapy·Breanne MeffordBrittany D Bissell
Mar 25, 2020·Critical Care Medicine·Alexander H Flannery, Marc Moss
Mar 25, 2020·Critical Care Medicine·Ivan Co, Robert C Hyzy

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