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The Incidence of hypotension with continuous infusion atracurium compared to cisatracurium in the Intensive Care Unit

BACKGROUND: A drug shortage of cisatracurium led to use of atracurium as an alternative neuromuscular blocker (NMB). Cisatracurium may be preferred due to less histamine release and potentially less hypotension. The study purpose is to compare the incidence of hypotension with continuous infusion at...

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Autores principales: VanderWeide, Luke A., Abdel-Rasoul, Mahmoud, Gerlach, Anthony Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479073/
https://www.ncbi.nlm.nih.gov/pubmed/28660165
http://dx.doi.org/10.4103/IJCIIS.IJCIIS_35_16
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author VanderWeide, Luke A.
Abdel-Rasoul, Mahmoud
Gerlach, Anthony Thomas
author_facet VanderWeide, Luke A.
Abdel-Rasoul, Mahmoud
Gerlach, Anthony Thomas
author_sort VanderWeide, Luke A.
collection PubMed
description BACKGROUND: A drug shortage of cisatracurium led to use of atracurium as an alternative neuromuscular blocker (NMB). Cisatracurium may be preferred due to less histamine release and potentially less hypotension. The study purpose is to compare the incidence of hypotension with continuous infusion atracurium to continuous infusion cisatracurium in ICU patients. MATERIALS AND METHODS: This retrospective cohort analysis reviewed 119 ICU patients who received either continuous infusion atracurium (56) or cisatracurium (63). The primary outcome was the incidence of hypotension (mean arterial pressure <60mmHg). Secondary outcomes included: incidence of blood pressure decrease of >20% from baseline, time to first hypotensive episode, treatment for hypotension during NMB use, hospital mortality, ICU and hospital length of stay (LOS), duration of mechanical ventilation (MV), and NMB duration. RESULTS: Hypotension occurred in 64.3% of atracurium patients and 58.7% of cisatracurium patients (P = 0.58), with 60.7% experiencing >20% drop in blood pressure in atracurium group and 54.0% in cisatracurium (P = 0.58). Median time to first hypotensive episode was 9.4[Interquartile range 1.17-19.7] hours atracurium and 4.4[1.5-13.9] hours cisatracurium (P = 0.36). There were no differences between atracurium and cisatracurium groups respectively for median ICU LOS (10.5 days and 12.4 days, P = 0.34), hospital LOS (14.0 days and 17.7 days, P = 0.37), MV duration (9.3 days and 10.5 days, P = 0.43), infusion duration (34.5 hours and 25 hours P = 0.27), or hospital mortality (62.5% and 53.9%, P = 0.336). Hypotension treatment was similar between groups. CONCLUSIONS: The incidence of hypotension was similar between atracurium and cisatracurium. Critical drug shortages may provide an opportunity to study alternative drug therapy.
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spelling pubmed-54790732017-06-28 The Incidence of hypotension with continuous infusion atracurium compared to cisatracurium in the Intensive Care Unit VanderWeide, Luke A. Abdel-Rasoul, Mahmoud Gerlach, Anthony Thomas Int J Crit Illn Inj Sci Original Article BACKGROUND: A drug shortage of cisatracurium led to use of atracurium as an alternative neuromuscular blocker (NMB). Cisatracurium may be preferred due to less histamine release and potentially less hypotension. The study purpose is to compare the incidence of hypotension with continuous infusion atracurium to continuous infusion cisatracurium in ICU patients. MATERIALS AND METHODS: This retrospective cohort analysis reviewed 119 ICU patients who received either continuous infusion atracurium (56) or cisatracurium (63). The primary outcome was the incidence of hypotension (mean arterial pressure <60mmHg). Secondary outcomes included: incidence of blood pressure decrease of >20% from baseline, time to first hypotensive episode, treatment for hypotension during NMB use, hospital mortality, ICU and hospital length of stay (LOS), duration of mechanical ventilation (MV), and NMB duration. RESULTS: Hypotension occurred in 64.3% of atracurium patients and 58.7% of cisatracurium patients (P = 0.58), with 60.7% experiencing >20% drop in blood pressure in atracurium group and 54.0% in cisatracurium (P = 0.58). Median time to first hypotensive episode was 9.4[Interquartile range 1.17-19.7] hours atracurium and 4.4[1.5-13.9] hours cisatracurium (P = 0.36). There were no differences between atracurium and cisatracurium groups respectively for median ICU LOS (10.5 days and 12.4 days, P = 0.34), hospital LOS (14.0 days and 17.7 days, P = 0.37), MV duration (9.3 days and 10.5 days, P = 0.43), infusion duration (34.5 hours and 25 hours P = 0.27), or hospital mortality (62.5% and 53.9%, P = 0.336). Hypotension treatment was similar between groups. CONCLUSIONS: The incidence of hypotension was similar between atracurium and cisatracurium. Critical drug shortages may provide an opportunity to study alternative drug therapy. Medknow Publications & Media Pvt Ltd 2017 /pmc/articles/PMC5479073/ /pubmed/28660165 http://dx.doi.org/10.4103/IJCIIS.IJCIIS_35_16 Text en Copyright: © 2017 International Journal of Critical Illness and Injury Science http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
VanderWeide, Luke A.
Abdel-Rasoul, Mahmoud
Gerlach, Anthony Thomas
The Incidence of hypotension with continuous infusion atracurium compared to cisatracurium in the Intensive Care Unit
title The Incidence of hypotension with continuous infusion atracurium compared to cisatracurium in the Intensive Care Unit
title_full The Incidence of hypotension with continuous infusion atracurium compared to cisatracurium in the Intensive Care Unit
title_fullStr The Incidence of hypotension with continuous infusion atracurium compared to cisatracurium in the Intensive Care Unit
title_full_unstemmed The Incidence of hypotension with continuous infusion atracurium compared to cisatracurium in the Intensive Care Unit
title_short The Incidence of hypotension with continuous infusion atracurium compared to cisatracurium in the Intensive Care Unit
title_sort incidence of hypotension with continuous infusion atracurium compared to cisatracurium in the intensive care unit
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479073/
https://www.ncbi.nlm.nih.gov/pubmed/28660165
http://dx.doi.org/10.4103/IJCIIS.IJCIIS_35_16
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