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

2021 ◽  
Author(s):  
Melissa L. Thompson Bastin ◽  
Rebecca R. Smith ◽  
Brittany D. Bissell ◽  
Heather N. Wolf ◽  
Alexandra M. Wiegand ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Fixed Dose ◽  
Train Of Four

scholarly journals Pharmacodynamics and Atracurium and Laudanosine Concentrations during a Fixed Continuous Infusion of Atracurium in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome

2002 ◽  
Vol 30 (4) ◽  
pp. 422-427 ◽  
Author(s):  
J-Y. Lefrant ◽  
C. Farenc ◽  
J-E. De La Coussaye ◽  
L. Muller ◽  
J. Ripart ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Renal Impairment ◽  
Respiratory Distress Syndrome ◽  
Liver Failure ◽  
Respiratory Distress ◽  
Continuous Infusion ◽  
Distress Syndrome ◽  
Fixed Rate ◽  
Mechanically Ventilated ◽  
Train Of Four

The present study was designed to assess the pharmacodynamics and the plasma levels of atracurium and laudanosine found during a 72-hour fixed rate infusion of atracurium in acute respiratory distress syndrome patients without renal or liver failure. Nine sedated and mechanically ventilated acute respiratory distress syndrome patients without renal or liver failure were paralysed with a bolus of atracurium (1 mg.kg -1 ) followed by a 72-hour continuous infusion (1 mg.kg -1 .h -1 ). The count of train-of-four (TOF) and TOF ratio were monitored by an accelerograph until full neuromuscular recovery (T4/T1 0.7). Atracurium and laudanosine concentrations were measured from the onset to four days after cessation of the infusion. An electroencephalogram was recorded daily. Analysis showed that TOF count was always 3 until cessation of the infusion. Following cessation, neuromuscular recovery occurred between 31 and 96 minutes (median value=45 min). The highest atracurium and laudanosine concentrations ranged from 3.3 to 5.8 μg.ml –1 and from 3 to 20 μg.ml –1 respectively. In four patients with renal impairment, the highest laudanosine concentration was > 10 μg.ml –1. No seizure was recorded. A fixed infusion rate of atracurium in acute respiratory distress syndrome patients provided an effective muscle paralysis with a rapid neuromuscular recovery but can lead to accumulation of laudanosine in patients with renal impairment.

Predictors of Cisatracurium Continuous Infusion Dose in Acute Respiratory Distress Syndrome

2019 ◽  
pp. 089719001988810
Author(s):  
Alison Merkel ◽  
Kyle Massey ◽  
Cassandra Bellamy ◽  
Todd Miano ◽  
Barry Fuchs ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Kidney Injury ◽  
Factors Affecting ◽  
Stable Dose ◽  
Optimal Dosing ◽  
Train Of Four ◽  
Time Required

Neuromuscular blockade (NMB) with cisatracurium may improve outcomes in the acute respiratory distress syndrome (ARDS) population; however, optimal dosing strategy remains unknown. Factors affecting pharmacokinetics and pharmacodynamics of cisatracurium may impact the dose required to achieve adequate train-of-four (TOF) response. The aims of this study were to determine cisatracurium dose requirements in a critically ill ARDS population and to identify clinical factors that affect dosing. This was a single-center, retrospective cohort study of medical intensive care patients who received cisatracurium infusion for treatment of ARDS. “Stable dose” was defined as the infusion rate producing 2 consecutive TOFs of 1/4 to 2/4. Factors examined for association with dose were temperature, pH, age, and the presence of acute kidney injury (AKI). The analysis included 39 patients. The median stable dose of cisatracurium was 2.8 (2.0, 3.1) μg/kg/min. Multivariable linear regression model for weight-normalized dose identified AKI as a factor independently associated with steady-state dose requirements (% change −31.4, 95% confidence interval [CI]: −51.9, −2.3). Our study provides information on cisatracurium doses required in patients with ARDS to reduce time required to reach goal TOF. Further studies are needed to determine effect of AKI on cisatracurium dose requirements and clinical outcomes.

Association Between Train-of-Four Values and Gas Exchange Indices in Moderate to Severe Acute Respiratory Distress Syndrome

2016 ◽  
Vol 50 (12) ◽  
pp. 1009-1015 ◽  
Author(s):  
Lara M. Groetzinger ◽  
Ryan M. Rivosecchi ◽  
Sandra L. Kane-Gill ◽  
Michael P. Donahoe
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Gas Exchange ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Neuromuscular Blockade ◽  
Distress Syndrome ◽  
Oxygenation Index ◽  
Poor Correlation ◽  
Arterial Blood ◽  
Train Of Four

Background: Acute respiratory distress syndrome (ARDS) is associated with a mortality rate of approximately 40%. Neuromuscular blockade is associated with an improvement in oxygenation and a reduction in mortality in ARDS. Objective: The goal of this evaluation was to determine if the depth of paralysis, determined by train-of-four (TOF) monitoring, correlates with gas exchange in moderate to severe ARDS. Methods: This was a retrospective review of moderate to severe ARDS patients who were prescribed >12 hours of continuous infusion cisatracurium between January 1, 2013, and December 31, 2014, with a PaO2:FiO2 ratio <150 and documented TOF and arterial blood gases. Patients were evaluated for inclusion at 12, 24, and 48 hours after initiation of neuromuscular blockade. Results: A total of 378 patients were screened for inclusion, with 107 evaluable patients meeting criteria at baseline. Poor correlation existed between TOF and oxygenation index (OI) at 12 (τ = 0.03), 24 (τ = 0.15) and 48 hours (τ = 0.08). When controlling for proning and baseline OI, the depth of paralysis did not have a significant effect on OI at 12, 24, or 48 hours. Conclusions: This evaluation demonstrates that the use of TOF monitoring for neuromuscular blockade does not correlate with gas exchange markers in moderate to severe ARDS.

COVID-19 – eine vaskuläre Systemerkrankung

2020 ◽  
Vol 49 (10) ◽  
pp. 418-421
Author(s):  
Christopher Werlein ◽  
Peter Braubach ◽  
Vincent Schmidt ◽  
Nicolas J. Dickgreber ◽  
Bruno Märkl ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome

ZUSAMMENFASSUNGDie aktuelle COVID-19-Pandemie verzeichnet mittlerweile über 18 Millionen Erkrankte und 680 000 Todesfälle weltweit. Für die hohe Variabilität sowohl der Schweregrade des klinischen Verlaufs als auch der Organmanifestationen fanden sich zunächst keine pathophysiologisch zufriedenstellenden Erklärungen. Bei schweren Krankheitsverläufen steht in der Regel eine pulmonale Symptomatik im Vordergrund, meist unter dem Bild eines „acute respiratory distress syndrome“ (ARDS). Darüber hinaus zeigen sich jedoch in unterschiedlicher Häufigkeit Organmanifestationen in Haut, Herz, Nieren, Gehirn und anderen viszeralen Organen, die v. a. durch eine Perfusionsstörung durch direkte oder indirekte Gefäßwandschädigung zu erklären sind. Daher wird COVID-19 als vaskuläre Multisystemerkrankung aufgefasst. Vor dem Hintergrund der multiplen Organmanifestationen sind klinisch-pathologische Obduktionen eine wichtige Grundlage der Entschlüsselung der Pathomechanismen von COVID-19 und auch ein Instrument zur Generierung und Hinterfragung innovativer Therapieansätze.

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