Comparison of three cisatracurium dosing strategies in acute respiratory distress syndrome: A focus on drug utilization and improvement in oxygenation.

Abstract

PURPOSE:

Three continuous dosing strategies of cisatracurium (CIS) for acute respiratory distress syndrome (ARDS) have been described in the literature. After implementation of a ventilator synchrony protocol (VSP), we sought to determine which continuous CIS dosing strategy utilized the least amount of drug without compromising efficacy.

METHODS:

We retrospectively reviewed patients with ARDS receiving continuous CIS from January 1, 2013 to December 31, 2018. We categorized patients into one of three dosing strategies: fixed dose (FD), titration based solely on train-of-four (TOF), or the VSP. We documented drug consumption and determined efficacy by comparing the change in PaO2/FiO2 ratio (P/F) and oxygenation index (OI) from baseline up to 48 h.

RESULTS:

A total of 1047 patients were screened, and 189 met inclusion criteria (VSP = 69, TOF = 99, FD = 21). Drug consumption (mg) was significantly lower in the VSP arm: 415 [IQR 318-528] compared to both the TOF: 665 [IQR 472-927] and the FD arms: 1730 [IQR 1695-1800], p < 0.001 for each. The change in P/F and OI from baseline were statistically equivalent at all time points.

CONCLUSION:

Without impacting efficacy of gas exchange, a protocol using ventilator synchrony for CIS titration required significantly less drug compared to TOF-based titration and a fixed dosing regimen.

• Authors: Julie N DiBridge, Ryan M Rivosecchi, Bryan J McVerry, Phillip E Lamberty, Michael P Donahoe, Lara M Groetzinger
• Journal: Journal of critical care (J Crit Care) Vol. 66 Pg. 166-172 (12 2021) ISSN: 1557-8615 [Electronic] United States
• PMID: 34301439 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Chemical References

• Atracurium
• cisatracurium

Topics

• Atracurium (analogs & derivatives)
• Drug Utilization
• Humans
• Respiratory Distress Syndrome (drug therapy)
• Retrospective Studies