Priya Vallabh, PharmD, BCPS
Critical Care Pharmacist
UMass Memorial Medical Center
Worcester, Massachusetts
Disclosure information not submitted.
Michael Ha, PharmD, BCPS, BCCCP
Critical Care Pharmacist
UMass Memorial Medical Center, United States
Disclosure information not submitted.
Krystina Ahern, PharmD, BCPS, BCCCP
Critical Care Pharmacist
UMass Memorial Medical Center, United States
Disclosure information not submitted.
Title: Efficacy and Safety of Vecuronium Compared to Cisatracurium in Acute Respiratory Distress Syndrome
Introduction: Previous studies analyzing neuromuscular blocking agents (NMBAs) in acute respiratory distress syndrome (ARDS) have evaluated the benefit of cisatracurium with conflicting results, and the data evaluating other NMBAs remains limited. The objective of this study was to compare the efficacy and safety of continuous infusion cisatracurium to vecuronium for neuromuscular blockade in ARDS.
Methods: This was a single-center, retrospective review of patients who received more than six hours of cisatracurium or vecuronium continuous infusions between October 1, 2017 and June 30, 2020 for ARDS. Patients were excluded if they received continuous neuromuscular blockade with both agents or for other indications during hospitalization. The primary endpoint was duration of mechanical ventilation. Secondary efficacy endpoints included change in PaO2/FiO2 ratio at 48-hours after initiation of NMBA infusion, intensive care unit (ICU) and hospital mortality, and ICU and hospital length of stay. Safety endpoints included newly developed myopathy, presence of bradycardia or hypotension, and newly developed barotrauma or volutrauma.
Results: 139 patients met inclusion criteria, and a final study population of 29 patients in each group was obtained after propensity score matching. Baseline ARDS severity was similar between cisatracurium and vecuronium groups (mean PaO2/FiO2 ratio 131.2 vs 124.2; p = 0.77) as was duration of respective NMBA infusion (mean 74.2 vs 69.6 hours; p = 0.77). There was no statistically significant difference in the primary efficacy endpoint of ventilator days between cisatracurium and vecuronium groups (mean 15.9 vs 20.5 days respectively; p = 0.2). Similar improvements in oxygenation status were seen comparing cisatracurium to vecuronium (mean change in PaO2/FiO2 29.8 vs 36.6; p = 0.74). ICU mortality was similar between groups (51.7%; p = 0.999) as was the incidence of newly developed myopathy (37.9%; p = 0.999). No statistically significant differences were found in any other secondary or safety endpoints.
Conclusions: No statistically significant differences were seen in efficacy or safety endpoints between cisatracurium or vecuronium for management of ARDS. These data suggest that vecuronium may be a safe alternative to cisatracurium for neuromuscular blockade in ARDS.