Vallabh Priya, Ha Michael, Ahern Krystina
Department of Pharmacy, 41528UMass Memorial Medical Center, Worcester, MA, USA.
J Intensive Care Med. 2023 Feb;38(2):188-195. doi: 10.1177/08850666221113504. Epub 2022 Jul 12.
Previous studies analyzing neuromuscular blocking agents (NMBAs) in acute respiratory distress syndrome (ARDS) have evaluated the benefit of cisatracurium with conflicting results, and data evaluating other NMBAs remains limited. The objective of this study was to compare the efficacy and safety of cisatracurium to vecuronium in ARDS.
A single-center, retrospective, propensity matched review of patients who received cisatracurium or vecuronium continuous infusions between October 1, 2017 and June 30, 2020 for ARDS was conducted. The primary endpoint was duration of mechanical ventilation. Secondary endpoints included change in PaO/FiO ratio at 48 h, intensive care unit (ICU) and hospital mortality, and ICU and hospital length of stay (LOS). Safety endpoints included newly developed myopathy, presence of bradycardia or hypotension, and newly developed barotrauma or volutrauma.
Twenty-nine patients were included in each group. There was no statistically significant difference in the primary endpoint of ventilator days between cisatracurium and vecuronium groups (mean 15.9 vs. 20.5 days respectively; = .2). No statistically significant differences were found in secondary endpoints of ICU mortality (51.7% vs. 51.7%) or length of stay (18.7 vs. 23.9 days, ), hospital mortality (51.7% vs. 55.2%, ) or length of stay (22 vs. 30.6 days, ), or mean change in PaO/FiO (29.8 vs. 36.6; ). Statistically significant differences were not observed in safety endpoints of myopathy (37.9% vs. 37.9%), barotrauma or volutrauma (13.8% vs. 3.5%; = .16), bradycardia (31% vs. 13.8%; = .12), or hypotension (96.6% vs. 82.8%; = .08).
No significant differences were seen in efficacy or safety endpoints between cisatracurium or vecuronium groups, suggesting that vecuronium may be a safe alternative agent for neuromuscular blockade in ARDS. Results of this analysis warrant confirmation in a larger, randomized study.
既往分析急性呼吸窘迫综合征（ARDS）中神经肌肉阻滞剂（NMBAs）的研究评估了顺式阿曲库铵的益处，但结果相互矛盾，且评估其他NMBAs的数据仍然有限。本研究的目的是比较顺式阿曲库铵与维库溴铵在ARDS中的疗效和安全性。
对2017年10月1日至2020年6月30日期间因ARDS接受顺式阿曲库铵或维库溴铵持续输注的患者进行单中心、回顾性、倾向匹配研究。主要终点是机械通气时间。次要终点包括48小时时的PaO/FiO2比值变化、重症监护病房（ICU）和医院死亡率以及ICU和医院住院时间（LOS）。安全性终点包括新发的肌病、心动过缓或低血压的发生情况以及新发的气压伤或容积伤。
每组纳入29例患者。顺式阿曲库铵组和维库溴铵组在机械通气天数这一主要终点上无统计学显著差异（分别为平均15.9天和20.5天；P = 0.2）。在ICU死亡率（51.7%对51.7%）或住院时间（18.7天对23.9天，P = 0.2）、医院死亡率（51.7%对55.2%，P = 0.6）或住院时间（22天对30.6天，P = 0.2）以及PaO/FiO2平均变化（29.8对36.6；P = 0.2）这些次要终点上未发现统计学显著差异。在肌病（37.9%对37.9%）、气压伤或容积伤（13.8%对3.5%；P = 0.16）、心动过缓（31%对13.8%；P = 0.12）或低血压（96.6%对82.8%；P = 0.08）这些安全性终点上未观察到统计学显著差异。
顺式阿曲库铵组和维库溴铵组在疗效或安全性终点上均未观察到显著差异，这表明维库溴铵可能是ARDS中神经肌肉阻滞的一种安全替代药物。本分析结果有待在更大规模的随机研究中得到证实。
