| Title |
How to reduce cisatracurium consumption in ARDS patients: the TOF-ARDS study
|
|---|---|
| Published in |
Annals of Intensive Care, August 2017
|
| DOI | 10.1186/s13613-017-0305-2 |
| Pubmed ID | |
| Authors |
Sami Hraiech, Jean-Marie Forel, Christophe Guervilly, Romain Rambaud, Samuel Lehingue, Mélanie Adda, Pierre Sylla, Sabine Valera, Julien Carvelli, Marc Gainnier, Laurent Papazian, Jérémy Bourenne |
| Abstract |
Neuromuscular blocking agents (NMBAs) have been shown to improve the outcome of the most severely hypoxemic, acute respiratory distress syndrome (ARDS) patients. However, the recommended dosage as well as the necessity of monitoring the neuromuscular block is unknown. We aimed to evaluate the efficiency of a nurse-directed protocol of NMBA administration based on a train-of-four (TOF) assessment to ensure a profound neuromuscular block and decrease cisatracurium consumption compared to an elevated and constant dose regimen. A prospective open labeled study was conducted in two medical intensive care units of two French university hospitals. Consecutive ARDS patients with a PaO2/FiO2 ratio less than 120 with a PEEP ≥5 cm H2O were included. Cisatracurium administration was driven by the nurses according to an algorithm based on TOF monitoring. The primary endpoint was cisatracurium consumption. The secondary endpoints included the quality of the neuromuscular block, the occurrence of adverse events, and the evolution of ventilatory and blood gas parameters. Thirty patients were included. NMBAs were used for 54 ± 30 h. According to this new algorithm, the initial dosage of cisatracurium was 11.8 ± 2 mg/h, and the final dosage was 14 ± 4 mg/h, which was significantly lower than in the ACURASYS study protocol (37.5 mg/h with a constant infusion rate (p < 0.001). The overall cisatracurium dose used was 700 ± 470 mg in comparison with 2040 ± 1119 mg for patients had received the ACURASYS dosage for the same period (p < 0.001). A profound neuromuscular block (TOF = 0, twitches at the ulnar site) was obtained from the first hour in 70% of patients. Modification of the cisatracurium dosage was not performed from the beginning to the end of the study in 60% of patients. Patient-ventilator asynchronies occurred in 4 patients. A nurse-driven protocol based on TOF monitoring for NMBA administration in ARDS patients was able to decrease cisatracurium consumption without significantly affecting the quality of the neuromuscular block. |
X Demographics
The data shown below were collected from the profiles of 15 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Spain | 5 | 33% |
| France | 1 | 7% |
| United States | 1 | 7% |
| Unknown | 8 | 53% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 10 | 67% |
| Scientists | 3 | 20% |
| Practitioners (doctors, other healthcare professionals) | 1 | 7% |
| Science communicators (journalists, bloggers, editors) | 1 | 7% |
Mendeley readers
The data shown below were compiled from readership statistics for 52 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 52 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Postgraduate | 8 | 15% |
| Researcher | 7 | 13% |
| Other | 5 | 10% |
| Student > Bachelor | 4 | 8% |
| Student > Master | 4 | 8% |
| Other | 11 | 21% |
| Unknown | 13 | 25% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 23 | 44% |
| Nursing and Health Professions | 7 | 13% |
| Pharmacology, Toxicology and Pharmaceutical Science | 2 | 4% |
| Business, Management and Accounting | 1 | 2% |
| Computer Science | 1 | 2% |
| Other | 1 | 2% |
| Unknown | 17 | 33% |
Attention Score in Context
This research output has an Altmetric Attention Score of 9. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 11 January 2020.
All research outputs
#3,807,807
of 23,577,654 outputs
Outputs from Annals of Intensive Care
#441
of 1,074 outputs
Outputs of similar age
#66,689
of 318,469 outputs
Outputs of similar age from Annals of Intensive Care
#8
of 22 outputs
Altmetric has tracked 23,577,654 research outputs across all sources so far. Compared to these this one has done well and is in the 83rd percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,074 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 17.2. This one has gotten more attention than average, scoring higher than 58% of its peers.
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We're also able to compare this research output to 22 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 63% of its contemporaries.