title: A comparison of two depths of prolonged neuromuscular blockade induced by cisatracurium in mechanically ventilated critically ill patients.
abstract: OBJECTIVE
  To compare two levels of continuous cisatracurium-induced curarization in hypoxemic, ventilated patients.
  
  
  METHODS
  An open-labeled, multicenter, prospective, randomized study.
  
  
  METHODS
  Hundred two patients with a ratio between arterial oxygen tension and inspired oxygen tension (PaO(2)/FIO(2)) less than 200 despite optimization of sedation and ventilation were randomized into group 1 (n=52) with an end point of no response at orbicularis oculi to train-of-four (TOF) stimulation or group 2 (n=50) with an end point of two responses.
  
  
  RESULTS
  The PaO(2)/FIO(2) and end-inspiratory plateau airway pressure (Pplat) were evaluated at baseline (before curarization) and at regular intervals once TOF end points had been attained for up to 2 h afterwards (T2 h). A decrease of 1 cmH(2)O or more of Pplat at T2 h compared to baseline was observed in 37% and 50% of the patients in groups 1 and 2, respectively (p=0.17). Time courses of PaO(2)/FIO(2) (mmHg) and Pplat (cmH(2)O) [mean (SD)] were equivalent in both groups, with a mild increase in PaO(2)/FIO(2) [p=0.0014; from 126 (33) to 141 (55) and from 134 (40) to 152 (52), respectively, in groups 1 and 2] and decrease in Pplat [p=0.016; from 29.1 (8.9) to 28.5 (8.8) and from 27.7 (7.5) to 26.6 (7.6)]. Median total durations of curarization were 28.9 h (3.1-219.7) in group 1 and 31.4 h (1.6-650.6) in group 2. Median cisatracurium infusion rates were 5.2 microg kg(-1) min(-1) (2.1-13.7) in group 1 and 3.6 microg kg(1) min(-1) (1.0-13.5) in group 2. The median delay to recovery from paralysis was shorter in group 2 (0.75 h vs 1.25 h; p=0.0008).
  
  
  CONCLUSIONS
  When a prolonged curarization is decided upon in an ICU patient, a blockade at 2/4 at TOF at orbicularis oculi has similar effects on respiratory parameters as a blockade at 0/4, allowing a decrease in total administered doses and a shortening of the recovery of muscle strength after cessation of infusion.
authors.affiliation: Department of Anesthesia and Intensive Care Unit, Beaujon Hospital, Université Paris VII, 100 boulevard du Général Leclerc, 92 118 Clichy Cedex, France. franck.lagneau@bjn.ap-hop-paris.fr
authors.forename: Franck
authors.initials: F
authors.lastname: Lagneau
authors.forename: Gilles
authors.initials: G
authors.lastname: D'honneur
authors.forename: Benoît
authors.initials: B
authors.lastname: Plaud
authors.forename: Jean
authors.initials: J
authors.lastname: Mantz
authors.forename: Thierry
authors.initials: T
authors.lastname: Gillart
authors.forename: Philippe
authors.initials: P
authors.lastname: Duvaldestin
authors.forename: Jean
authors.initials: J
authors.lastname: Marty
authors.forename: Nathalie
authors.initials: N
authors.lastname: Clyti
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pourriat
mesh_terms: D000704:Analysis of Variance; D001279:Atracurium / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D016292:Procedural Sedation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000379:methods*; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome
chemical_list: D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium