Intensive Care Medicine

, Volume 28, Issue 12, pp 1735–1741

A comparison of two depths of prolonged neuromuscular blockade induced by cisatracurium in mechanically ventilated critically ill patients

  • Franck Lagneau
  • Gilles D'honneur
  • Benoît Plaud
  • Jean Mantz
  • Thierry Gillart
  • Philippe Duvaldestin
  • Jean Marty
  • Nathalie Clyti
  • Jean-Louis Pourriat
Original

Abstract

Objectives. To compare two levels of continuous cisatracurium-induced curarization in hypoxemic, ventilated patients.

Design and setting. An open-labeled, multicenter, prospective, randomized study.

Patients. Hundred two patients with a ratio between arterial oxygen tension and inspired oxygen tension (PaO2/FIO2) 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.

Measurements and results. The PaO2/FIO2 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 cmH2O 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 PaO2/FIO2 (mmHg) and Pplat (cmH2O) [mean (SD)] were equivalent in both groups, with a mild increase in PaO2/FIO2 [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 µg kg–1 min–1 (2.1–13.7) in group 1 and 3.6 µg kg1 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).

Conclusion. 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.

Intensive care unit (ICU) Mechanical ventilation Neuromuscular blockade Cisatracurium Train-of-four (TOF) Depth of blockade 

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Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Franck Lagneau
    • 1
  • Gilles D'honneur
    • 2
  • Benoît Plaud
    • 3
  • Jean Mantz
    • 4
  • Thierry Gillart
    • 5
  • Philippe Duvaldestin
    • 2
  • Jean Marty
    • 1
  • Nathalie Clyti
    • 6
  • Jean-Louis Pourriat
    • 7
  1. 1.Department of Anesthesia and Intensive Care Unit, Beaujon Hospital, Université Paris VII, 100 boulevard du Général Leclerc, 92 118 Clichy Cedex, France
  2. 2.Department of Anesthesia and Intensive Care Unit, Henri-Mondor Hospital, 94000 Créteil, France
  3. 3.Department of Anesthesia and Intensive Care Unit, Rothschild Foundation, 75012 Paris, France
  4. 4.Department of Anesthesia and Intensive Care Unit, Bichat Hospital, 75018 Paris, France
  5. 5.Department of Anesthesia and Intensive Care Unit, Montpied Hospital, 63000 Clermont-Ferrand, France
  6. 6.GlaxoSmithKline, 78160 Marly-le-Roy, France
  7. 7.Department of Anesthesia and Intensive Care Unit, Jean Verdier Hospital, 93140 Bondy, France

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