Jessica Davis
University of Louisville Hospital
Louisville, Kentucky
Disclosure information not submitted.
Kristen Livers, PharmD, BCCCP
Critical Care Clinical Pharmacy Supervisor
UofL Health - UofL Hospital, United States
Disclosure information not submitted.
Christine Duff, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist
University of Louisville Hospital, United States
Disclosure information not submitted.
Brittany Dean, PharmD Candidate 2021
Pharmacy Student
University of Kentucky College of Pharmacy, United States
Disclosure information not submitted.
Rachel Williams, BCCCP, BCPS, PharmD
MICU Clinical Pharmacist Specialist
UofL Health - UofL Hospital, United States
Disclosure information not submitted.
Title: Sedation During Chemical Paralysis With Cisatracurium in Acute Respiratory Distress Syndrome
Introduction: Patients undergoing chemical paralysis are at risk of conscious paralysis due to the inability to behaviorally assess sedation in the paralyzed patient. The bispectral index (BIS) offers an objective alternative to assessing sedation; however, a target range for use in sustained paralysis has not yet been defined. Our study aims to evaluate sedation requirements in patients receiving sustained neuromuscular blockade for treatment of acute respiratory distress syndrome (ARDS) before and during chemical paralysis with cisatracurium.
Methods: A single-center, retrospective, observational study was conducted utilizing the electronic medical record (EMR). Our study evaluated the percentage of patients with ARDS under chemical paralysis in which the rate of sedation decreased after initiation of a neuromuscular blocking agent (NMBA).
Results: Sedation was decreased in response to interpreted oversedation from a BIS value in 34 of 40 patients (85%) after the initiation of chemical paralysis. Of these, sedation was decreased on average 4.26 times. Patients spent on average 52% of the time outside of BIS range of 40-60. A total of 6 patients (15%) required additional 1-time doses of sedative or analgesic agents. A correlation between the BIS and Richmond Agitation and Sedation Score (RASS) upon emergence from chemical paralysis was not observed (r=-0.160).
Conclusions: Titrating sedation to a BIS value resulted in a decrease in sedation in 85% of patients receiving sustained chemical paralysis. Adequate sedation during chemical paralysis with cisatracurium may not be directly related to a BIS range in all patients with ARDS.