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

Lagneau, F; Dhonneur, Gilles; Plaud, Benoît; Mantz, Jean; Gillart, Thierry; Duvaldestin, P.; Marty, J.; Clyti, N.; Pourriat, Jean-Louis

doi:10.1007/s00134-002-1508-y

Cited by 48 publications

(29 citation statements)

References 19 publications

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“…Rudis et al 26 reported that lower doses of NMBAs were used and recovery from paralytic agents was faster in patients randomized to TOF-guided therapy, whereas 2 other studies 27,28 showed no difference between groups in total paralysis time, recovery time, and amount of drug used. In a randomized controlled trial 29 of 102 patients with ARDS who were given cisatracurium, Figure 4 Degree to which baseline factors or concurrent therapies are perceived to alter the risk profile of neuromuscular blocking agents. This study had several possible limitations.…”

Section: Discussionmentioning

confidence: 99%

Intensive Care Nurses' Knowledge About Use of Neuromuscular Blocking Agents in Patients With Respiratory Failure

Frazee¹,

Personett²,

Bauer³

et al. 2015

American Journal of Critical Care

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Section: Discussionmentioning

confidence: 99%

Intensive Care Nurses' Knowledge About Use of Neuromuscular Blocking Agents in Patients With Respiratory Failure

Frazee¹,

Personett²,

Bauer³

et al. 2015

American Journal of Critical Care

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“…Coggeshall et al 29 reported a case in which the use of NMBA improved gas exchange. In 102 adult patients in acute respiratory distress with a PaO 2 /FiO 2 Ͻ200, Lagneau et al 35 noted that whatever the level of paralysis (2 or no response to the train-of-4), there was a significant improvement in the PaO 2 /FiO 2 ratio after 30 minutes and after 2 hours of continuous administration of cisatracurium, when compared with before NMBA. 28 Effects of NMBA on Gas Exchange in Patients With ARDS main hypotheses to explain this effect were a decrease in oxygen consumption and a better adaptation to mechanical ventilation as soon as cisatracurium was infused.…”

Section: The Effects Of the Use Of Neuromuscularblocking Agents On Gamentioning

confidence: 97%

“…28 Effects of NMBA on Gas Exchange in Patients With ARDS main hypotheses to explain this effect were a decrease in oxygen consumption and a better adaptation to mechanical ventilation as soon as cisatracurium was infused. The study by Lagneau et al 35 was not designed to analyze the effect of NMBA on gas exchange and there was no control group; each subject was compared before and after NMBA infusion. In a prospective, controlled, randomized, multicenter study, 36 we evaluated the effects of a 48-hour NMBA infusion on gas exchange over a 120-hour time period in 56 patients with ARDS (PaO 2 /FiO 2 Ͻ50 mm Hg with a PEEP of at least 5 cm H 2 O).…”

Section: The Effects Of the Use Of Neuromuscularblocking Agents On Gamentioning

confidence: 99%

The Effects of Neuromuscular-Blocking Agents on Gas Exchange in Patients With Acute Respiratory Distress Syndrome

Forel

Chiche

Papazian

2006

Clinical Pulmonary Medicine

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The use of neuromuscular-blocking agents (NMBA) in ventilated patients with acute respiratory distress syndrome (ARDS) is controversial and largely empiric. Few trials looked at their effectiveness on gas exchange or in improving lung mechanics in patients with ARDS. Only one randomized, controlled trial compared the effects of NMBA on gas exchange in patients with ARDS receiving NMBA as compared with patients receiving placebo throughout a period of 48 hours. In this trial, the early use of NMBA in patients with ARDS was associated with a sustained improvement in oxygenation. The muscular paralysis induced by NMBA could reduce the consumption of oxygen linked to the work of breathing. Muscular paralysis could facilitate mechanical ventilation by preventing spontaneous breaths responsible for the dys-synchrony and worsening of gas exchange. Muscular paralysis could increase compliance of the thoracic wall and improve mechanical ventilation during ARDS. However, these hypotheses are controversial. Finally, preliminary data show that the muscular paralysis could provide better adaptation to mechanical ventilation and better satisfaction with the protective criteria for reduction of ventilator-associated lung injuries by homogenizing the distribution of tidal volume and positive end expiratory pressure. The role of new NMBA (benzylisoquinolines) in the occurrence of critical illness neuromyopathy is largely questioned in the recent literature. It is important to design new studies to explain the mechanisms of the improvement in oxygenation associated with NMBA and to evaluate whether the use of NMBA modifies the outcome of patients with ARDS.

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“…The effort to improve postoperative respiratory muscle function and avoid respiratory failure begins with surgical and anesthetic planning: minimally invasive techniques 56,116,199 and 215,227 Diaphragmatic dysfunction Minimize diaphragmatic immobility 147,157,228 Respiratory muscle exercise 161 Sasaki et al…”

Section: Strategies To Prevent Postoperative Respiratory Failurementioning

confidence: 99%

Postoperative Respiratory Muscle Dysfunction

2013

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Postoperative pulmonary complications are responsible for significant increases in hospital cost as well as patient morbidity and mortality; respiratory muscle dysfunction represents a contributing factor. Upper airway dilator muscles functionally resist the upper airway collapsing forces created by the respiratory pump muscles. Standard perioperative medications (anesthetics, sedatives, opioids, and neuromuscular blocking agents), interventions (patient positioning, mechanical ventilation, and surgical trauma), and diseases (lung hyperinflation, obesity, and obstructive sleep apnea) have differential effects on the respiratory muscle subgroups. These effects on the upper airway dilators and respiratory pump muscles impair their coordination and function and can result in respiratory failure. Perioperative management strategies can help decrease the incidence of postoperative respiratory muscle dysfunction. Such strategies include minimally invasive procedures rather than open surgery, early and optimal mobilizing of respiratory muscles while on mechanical ventilation, judicious use of respiratory depressant anesthetics and neuromuscular blocking agents, and noninvasive ventilation when possible.

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

Cited by 48 publications

References 19 publications

Intensive Care Nurses' Knowledge About Use of Neuromuscular Blocking Agents in Patients With Respiratory Failure

Intensive Care Nurses' Knowledge About Use of Neuromuscular Blocking Agents in Patients With Respiratory Failure

The Effects of Neuromuscular-Blocking Agents on Gas Exchange in Patients With Acute Respiratory Distress Syndrome

Postoperative Respiratory Muscle Dysfunction

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