How to reduce cisatracurium consumption in ARDS patients: the TOF-ARDS study View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-08-02

AUTHORS

Sami Hraiech, Jean-Marie Forel, Christophe Guervilly, Romain Rambaud, Samuel Lehingue, Mélanie Adda, Pierre Sylla, Sabine Valera, Julien Carvelli, Marc Gainnier, Laurent Papazian, Jérémy Bourenne

ABSTRACT

BackgroundNeuromuscular blocking agents (NMBAs) have been shown to improve the outcome of the most severely hypoxemic, acute respiratory distress syndrome (ARDS) patients. However, the recommended dosage as well as the necessity of monitoring the neuromuscular block is unknown. We aimed to evaluate the efficiency of a nurse-directed protocol of NMBA administration based on a train-of-four (TOF) assessment to ensure a profound neuromuscular block and decrease cisatracurium consumption compared to an elevated and constant dose regimen. A prospective open labeled study was conducted in two medical intensive care units of two French university hospitals. Consecutive ARDS patients with a PaO2/FiO2 ratio less than 120 with a PEEP ≥5 cm H2O were included. Cisatracurium administration was driven by the nurses according to an algorithm based on TOF monitoring. The primary endpoint was cisatracurium consumption. The secondary endpoints included the quality of the neuromuscular block, the occurrence of adverse events, and the evolution of ventilatory and blood gas parameters.ResultsThirty patients were included. NMBAs were used for 54 ± 30 h. According to this new algorithm, the initial dosage of cisatracurium was 11.8 ± 2 mg/h, and the final dosage was 14 ± 4 mg/h, which was significantly lower than in the ACURASYS study protocol (37.5 mg/h with a constant infusion rate (p < 0.001). The overall cisatracurium dose used was 700 ± 470 mg in comparison with 2040 ± 1119 mg for patients had received the ACURASYS dosage for the same period (p < 0.001). A profound neuromuscular block (TOF = 0, twitches at the ulnar site) was obtained from the first hour in 70% of patients. Modification of the cisatracurium dosage was not performed from the beginning to the end of the study in 60% of patients. Patient–ventilator asynchronies occurred in 4 patients.ConclusionA nurse-driven protocol based on TOF monitoring for NMBA administration in ARDS patients was able to decrease cisatracurium consumption without significantly affecting the quality of the neuromuscular block. More... »

PAGES

79

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s13613-017-0305-2

DOI

http://dx.doi.org/10.1186/s13613-017-0305-2

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https://app.dimensions.ai/details/publication/pub.1090955543

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28770545


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    "description": "BackgroundNeuromuscular blocking agents (NMBAs) have been shown to improve the outcome of the most severely hypoxemic, acute respiratory distress syndrome (ARDS) patients. However, the recommended dosage as well as the necessity of monitoring the neuromuscular block is unknown. We aimed to evaluate the efficiency of a nurse-directed protocol of NMBA administration based on a train-of-four (TOF) assessment to ensure a profound neuromuscular block and decrease cisatracurium consumption compared to an elevated and constant dose regimen. A prospective open labeled study was conducted in two medical intensive care units of two French university hospitals. Consecutive ARDS patients with a PaO2/FiO2 ratio less than 120 with a PEEP \u22655\u00a0cm H2O were included. Cisatracurium administration was driven by the nurses according to an algorithm based on TOF monitoring. The primary endpoint was cisatracurium consumption. The secondary endpoints included the quality of the neuromuscular block, the occurrence of adverse events, and the evolution of ventilatory and blood gas parameters.ResultsThirty patients were included. NMBAs were used for 54\u00a0\u00b1\u00a030\u00a0h. According to this new algorithm, the initial dosage of cisatracurium was 11.8\u00a0\u00b1\u00a02\u00a0mg/h, and the final dosage was 14\u00a0\u00b1\u00a04\u00a0mg/h, which was significantly lower than in the ACURASYS study protocol (37.5\u00a0mg/h with a constant infusion rate (p\u00a0<\u00a00.001). The overall cisatracurium dose used was 700\u00a0\u00b1\u00a0470\u00a0mg in comparison with 2040\u00a0\u00b1\u00a01119\u00a0mg for patients had received the ACURASYS dosage for the same period (p\u00a0<\u00a00.001). A profound neuromuscular block (TOF\u00a0=\u00a00, twitches at the ulnar site) was obtained from the first hour in 70% of patients. Modification of the cisatracurium dosage was not performed from the beginning to the end of the study in 60% of patients. Patient\u2013ventilator asynchronies occurred in 4 patients.ConclusionA nurse-driven protocol based on TOF monitoring for NMBA administration in ARDS patients was able to decrease cisatracurium consumption without significantly affecting the quality of the neuromuscular block.", 
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