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

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