Melissa L Thompson Bastin1, Rebecca R Smith2, Brittany D Bissell3, Heather N Wolf4, Alexandra M Wiegand5, Megan E Cavagnini6, Yahya Ahmad7, Alexander H Flannery8. 1. University of Kentucky HealthCare, Department of Pharmacy Services, United States of America; University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science, United States of America. Electronic address: mlthompson@uky.edu. 2. University of Arkansas for Medical Sciences, Department of Pharmacy Services, United States of America. Electronic address: rrsmith@uams.edu. 3. University of Kentucky HealthCare, Department of Pharmacy Services, United States of America; University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science, United States of America; University of Kentucky College of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, United States of America. Electronic address: brittany.bissell@uky.edu. 4. St. Elizabeth Healthcare, Department of Pharmacy Services, United States of America. Electronic address: heather.wolf@stelizabeth.com. 5. University of Kentucky HealthCare, Department of Pharmacy Services, United States of America. Electronic address: ali.wiegand@uky.edu. 6. University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science, United States of America. Electronic address: megan.cavagnini@uky.edu. 7. University of Kentucky College of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, United States of America. Electronic address: yrah222@uky.edu. 8. University of Kentucky HealthCare, Department of Pharmacy Services, United States of America; University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science, United States of America. Electronic address: Alex.Flannery@uky.edu.
Abstract
PURPOSE: 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). MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: Fixed-dose cisatracurium was associated with similar ventilatory and clinical outcomes compared to titrated strategy, yet it was associated with a 3-fold increase in dose administered.
PURPOSE: 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). MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: Fixed-dose cisatracurium was associated with similar ventilatory and clinical outcomes compared to titrated strategy, yet it was associated with a 3-fold increase in dose administered.
Authors: Jonathan Rodríguez-Blanco; Tomás Rodríguez-Yanez; Jesús Daniel Rodríguez-Blanco; Amilkar José Almanza-Hurtado; María Cristina Martínez-Ávila; Diana Borré-Naranjo; María Camila Acuña Caballero; Carmelo Dueñas-Castell Journal: J Int Med Res Date: 2022-09 Impact factor: 1.573