Cisatracurium Continuous Infusion Versus No Neuromuscular Blockade for Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation.
Adult
Aged
Atracurium
/ administration & dosage
Body Mass Index
Extracorporeal Membrane Oxygenation
/ methods
Female
Hospital Mortality
Humans
Infusions, Intravenous
Length of Stay
Male
Middle Aged
Neuromuscular Blockade
/ methods
Organ Dysfunction Scores
Respiration, Artificial
/ methods
Respiratory Distress Syndrome
/ mortality
Retrospective Studies
acute respiratory distress syndrome
cisatracurium
clinical pharmacology
critical care
extracorporeal membrane oxygenation
neuromuscular blockade
paralysis
pharmacology
pulmonary
Journal
Journal of clinical pharmacology
ISSN: 1552-4604
Titre abrégé: J Clin Pharmacol
Pays: England
ID NLM: 0366372
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
27
04
2021
accepted:
22
06
2021
pubmed:
29
6
2021
medline:
17
2
2022
entrez:
28
6
2021
Statut:
ppublish
Résumé
The benefit of continuous infusion neuromuscular blockade concurrently with venovenous (VV) extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome who are receiving mechanical ventilation remains unclear. Adult patients with severe acute respiratory distress syndrome requiring VV ECMO were analyzed in 2 groups: continuous infusion neuromuscular blockade with cisatracurium vs no neuromuscular blockade. Similar mechanical ventilation strategies were used. The primary end point was duration of VV ECMO. This single-center, retrospective observational cohort included a total of 47 patients, 28 of whom received continuous infusion cisatracurium and 19 patients who did not receive neuromuscular blockade. There was no difference in the duration of VV ECMO in patients who received cisatracurium, 226.5 hours (interquartile range, 119-362.3) vs 187.0 hours (interquartile range, 108-374) in the group who did not receive a paralytic (P = .64). There were no differences in secondary outcomes of days in the hospital, days free of organ dysfunction, ECMO survival, or discharged alive. Among patients with severe ARDS who were managed with VV ECMO, patients who received continuous infusion cisatracurium had no difference in the duration of VV ECMO compared to the nonparalytic comparator group.
Substances chimiques
Atracurium
2GQ1IRY63P
cisatracurium
QX62KLI41N
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1415-1420Informations de copyright
© 2021, The American College of Clinical Pharmacology.
Références
Force ADT, Ranieri VM, Rubenfeld GD. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526-2533.
Reilly JP, Calfee CS, Christie JD. Acute respiratory distress syndrome phenotypes. Semin Respir Crit Care Med. 2019;40(1):19-30.
Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301-1308.
Guerin C, Reignier J, Richard JC. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159-2168.
Meduri GU, Golden E, Freire AX. Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest. 2007;131(4):954-963.
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network, Wiedemann HP. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564-2575.
Peek GJ, Mugford M, Tiruvoipati R. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351-1363.
Steinberg KP, Hudson LD, Goodman RB. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med. 2006;354(16):1671-1684.
National Heart, Lung, and Blood Institute PETAL Clinical Trials Network, Moss M, Huang DT, et al. Early neuromuscular blockade in the acute respiratory distress syndrome. N Engl J Med. 2019;380(21):1997-2008.
Mefford B, Donaldson JC, Bissell BD. To block or not: updates in neuromuscular blockade in acute respiratory distress syndrome. Ann Pharmacother. 2020;54(9):899-906.
Yehya N, Harhay MO, Curley MAQ, Schoenfeld DA, Reeder RW. Reappraisal of ventilator-free days in critical care research. Am J Respir Crit Care Med. 2019;200(7):828-836.
Papazian L, Forel JM, Gacouin A. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107-1116.
IBM Corp. IBM SPSS Statistics for Windows Version 27.0. Armonk, NY: IBM Corp.; 2020.
Wang J, Wang Y, Wang T, Xing X, Zhang G. Is extracorporeal membrane oxygenation the standard care for acute respiratory distress syndrome: a systematic review and meta-analysis. Heart Lung Circ. 2021;30(5):631-641.