title: Comparison of Cisatracurium Versus Atracurium in Early ARDS.
abstract: BACKGROUND
  Administration of cisatracurium in severe ARDS decreases in-hospital mortality. Whether clinical outcomes are cisatracurium-specific or related with all neuromuscular blockers is unknown. This study aimed to compare outcomes in severe ARDS patients treated with cisatracurium versus atracurium.
  
  
  METHODS
  Patients admitted in ICUs with a diagnosis of severe ARDS and treated with neuromuscular blocking agents within 72 h of diagnosis were included. Subjects treated with cisatracurium versus atracurium were compared. The primary outcome was improvement in oxygenation, defined as the difference of PaO2/FIO2at 72 h post-initiation of neuromuscular blocking agents. Secondary outcomes were ventilator-free days at day 28, ICU and hospital lengths of stay, and hospital mortality.
  
  
  RESULTS
  Seventy-six subjects with ARDS were included in the study. Eighteen subjects (24%) were treated with atracurium, whereas 58 (76%) were treated with cisatracurium. Equivalent dosages of sedation and analgesia as well as use of brain function monitoring technology were similar between both groups. There were no differences in clinical outcomes. Specifically, improvement of PaO2/FIO2was a median (interquartile range [IQR]) of 65 (25-162) in the atracurium group and 66 (IQR 16-147) in the cisatracurium group (P= .65). Ventilator-free days at day 28 were 13 d (IQR 0-22 d) and 15 d (IQR 8-21 d) in the atracurium and cisatracurium groups, respectively (P= .72). ICU length or stay was 18 d (IQR 8-34 d) in the atracurium group and 15 d (IQR 9-22 d) in the cisatracurium group (P= .34). In-hospital mortality was 50% for the atracurium population and 62% for the cisatracurium group (P= .42) CONCLUSIONS: Among subjects with early severe ARDS, the utilization of atracurium versus cisatracurium within 72 h of admission was not associated with significant differences in clinical outcomes.
authors.affiliation: Department of Pharmacy.
authors.forename: Leanne
authors.initials: L
authors.lastname: Moore
authors.affiliation: Department of Pharmacy.
authors.forename: Charles Joseph
authors.initials: CJ
authors.lastname: Kramer
authors.affiliation: Department of Clinical Effectiveness.
authors.forename: Sophie
authors.initials: S
authors.lastname: Delcoix-Lopes
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center, Dallas, Texas. ariel.modrykamien@baylorhealth.edu.
authors.forename: Ariel M
authors.initials: AM
authors.lastname: Modrykamien
mesh_terms: D000328:Adult; D000368:Aged; D001279:Atracurium / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage*; D010101:Oxygen Consumption / Q000187:drug effects; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium
keywords: ARDS; mechanical ventilation; neuromuscular blockers; oxygenation