危重症成人持续神经肌肉阻滞中持续输注罗库溴铵的评估。

An Evaluation of Continuous Infusion Rocuronium for Sustained Neuromuscular Blockade in Critically Ill Adults.

机构信息

University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA, USA.

Nebraska Medicine, Omaha, NE, USA.

出版信息

Ann Pharmacother. 2021 Jun;55(6):732-737. doi: 10.1177/1060028020966731. Epub 2020 Oct 10.

DOI:10.1177/1060028020966731

PMID:33043678

Abstract

BACKGROUND

Recent medication shortages of the neuromuscular blocking agent (NMBA) cisatracurium have forced the prescribing of aminosteroidal agents such as rocuronium. There are limited data on the use and dosing of continuous infusion (CI) rocuronium in critically ill patients outside of the operating room.

OBJECTIVE

We sought to describe the use of CI rocuronium for sustained neuromuscular blockade in intensive care unit (ICU) patients by characterizing the dosing, utilization, and safety profile in patients with multiple organ failure (MOF) and non-MOF.

METHODS

This was a retrospective review of patients in mixed ICUs from 2 tertiary medical centers who received CI rocuronium between January 2018 and July 2019.

RESULTS

A total of 46 unique rocuronium infusions were utilized for 40 patients during the evaluation period. Of these, 37% had MOF, and 41% had at least 1 organ fail during the rocuronium infusion. The median starting and maximum dose was 8 µg/kg/min. Overall, 64% of train of 4 (TOF) measurements were a TOF 0 (T0) or TOF 1 (T1), with a higher percentage of T0 or T1 in the MOF group compared with the non-MOF group (75% vs 50%). The median time to recovery was more than twice as long for the MOF compared with the non-MOF group (10 vs 4.6 hours). ICU-acquired weakness was diagnosed in 27% of survivors.

CONCLUSION AND RELEVANCE

In ICU patients with MOF, continuous rocuronium infusions were associated with deep levels of paralysis and prolonged recovery times. If neuromuscular blockade is required for critically ill patients, alternative strategies could be considered.

摘要

背景

最近神经肌肉阻滞剂（NMBA）顺式阿曲库铵短缺，迫使开瑞琼等氨甾体类药物。在手术室之外，关于危重病患者连续输注（CI）罗库溴铵的使用和剂量的数据有限。

目的

我们旨在通过描述多器官衰竭（MOF）和非 MOF 患者的剂量、利用和安全性特征，描述 CI 罗库溴铵在重症监护病房（ICU）患者中用于持续神经肌肉阻滞的情况。

方法

这是对 2018 年 1 月至 2019 年 7 月期间在 3 家医疗中心接受 CI 罗库溴铵治疗的混合 ICU 患者的回顾性研究。

结果

在评估期间，共有 40 名患者使用了 46 种独特的罗库溴铵输注。其中，37%的患者有 MOF，41%的患者在罗库溴铵输注期间至少有 1 个器官衰竭。起始和最大剂量中位数为 8μg/kg/min。总体而言，64%的 4 次肌颤搐（TOF）测量结果为 TOF0（T0）或 TOF1（T1），MOF 组的 T0 或 T1 百分比高于非 MOF 组（75%比 50%）。MOF 组的恢复时间中位数比非 MOF 组长两倍以上（10 比 4.6 小时）。幸存者中有 27%诊断为 ICU 获得性肌无力。