Table 7 ICU studies of mechanically ventilated patients receiving neuromuscular blockers
| Â | Newman52 | Rudis53 | Kupfer54 | Douglass55 | Prielipp4 | Segredo56 |
|---|---|---|---|---|---|---|
Study type | Prospective | Prospective | Prospective | Retrospective | Prospective | Prospective |
Randomized | Yes | Yes | No | No | Yes | No |
Patients | ICU | ICU | VEC > 6 hrs | Asthma | ICU | VEC>24 hrs |
# of subjects | 61 | 77 | 10 | 25 | 54 | 16 |
Mean age(yrs) | 51 | 54 | 34 | 39 | 49 | Â |
Apache score | 18 | 73 | Â | Â | 27 | Â |
Neuromuscular blocker | CISATRA (n = 40) ATRA (n = 21) | VEC (n = 35 standard Assessment; N= 42 nerve stim) 65 survivors | VEC | VEC 22 of 25 pts | CISTATRA (n = 28) VEC (n = 30) | VEC |
Dose (mean) | CISATRA 3.1 ug/kg/min ATRA 10.4 ug/kg/min | VEC load 0.08 mg/kg infusion 0.08 mg/kg/hr dosing individualized | Â | 492 mg (SD692 mg) | CISTATRA 2.6 mg/kg/hr VEC 0.9 mg/kg/hr twitch monitor | Â |
Duration of infusion | 47 hrs | Standard assessment- 55.1 +/- 34.3 hrs Nerve stimulation 43.2 +/- 31.8 | Â | 6.6 days | CISTATRA 80 +/- 7 h VEC 66 +/- 12 h. | Â |
Recovery from block | 1 hour 70% TOF for both drugs | 50% of control pts recovery was 3.5 hrs (95% CI 2–8) vs. 1.7 hrs (95% CI 1–2) in nerve stim patients | 7/10 pts with weakness, 3/10 muscle wasting, 2/10 difficulty weaning |  | 70% TOF ratio CISTATRA 68 +/- 13 min VEC 387 +/- 163 min, longer (P = 0.02) | 7 of 16 pts had prolonged block (l6 hrs – 7 days) |
Neuro- muscular Outcome | No patient showed evidence of weakness following discontinuation of either CISATRA or ATRA | Median time for 50% of control pts to breathe spontaneously was 4.8 hrs (95% CI 3–9) compared with 2 hrs (95% CI 2–5) 11 of 35 control pts had prolonged block (>4 hr) 5/42 perip nerve stim pts had long block (p < .05) 3 survivors needed physical therapy for 35 to 137 days | Pts with polyneuropathy 1352 mg in 7.2 days Without polyneuropathy 528 mg for 3.8 days (p0.04) | 9/25 had weakness Patients with myopathy had significantly higher total dose of VEC (p < 0.001) | Prolonged recovery CISTATRA: 2 patients VEC : 13 patients P = 0.002 1 VEC patient significant myopathy |  |
| Â | deLemos 57 | Khuenl-Brady 58 | Leatherman 59 | Coakley 60 | Murray 61 | Coakley 62 |
Study Type | Prospective | Prospective | Retrospective | Prospective | Prospective | Prospective |
Randomized | No | No | No | No | Yes | No |
Patients | ICU | Block > 2 days | Asthma | ICU >7 days | ICU | ICU >7 days |
# of subjects | 30 | 60 | 107 | 44 | 40 | 23 |
Mean age (yrs) | 42 | 36 | Â | 60 | 52 | 55 |
Apache | 26 | Â | Â | 19 | 27 | 15.9 |
Neuromusc. blocker | PANC with TOF titrate | PANC (n = 30) PIPE (n = 30) | ATRA, PANC, VEC | Â | DOX, PANC | 15 of 23 received |
Dose (mean) | Intermittent group (n = 14) 0.02 mg/kg/hr) Continuous Infusion (n = 16) .04 mg/kg/hr | 3 mg/h with both | Â | Â | DOX (0.04 mg/kg) PANC (0.07 mg/kg) | Â |
Duration Of infusion | 6 days | > 48 hrs | Â | > 7 days | 2.5 days | Â |
Recovery from block | Median time to recover from paralysis was 3.5 hrs (1.82–5.18) in infusion group vs. 6.3 hrs (3.40–9.19) in intermittent bolus group (p =.10) |  | Corticosteroids associated with more muscle weakness 20 of 69 versus 0 of 38 (p < 0.001) |  |  |  |
Neuro- muscular Outcome | 5 in the infusion group and 1 intermittent had persistent severe muscle weakness 3 from each group had prolonged recovery >12 hrs. | None of the patients had muscle weakness | 20 weak patients were paralysed longer 3.4 +/- 2.4 versus 0.6 +/- 0.7 d (p < 0.001) 18 of 20 weak pts paralysed > 24 h. | 19 had motor & sensory findingss no relationship between neurophys. abnormality & APACHE II score, organ failure, sepsis, muscle relaxant, or steroids Mortality 23% | DOX shorter recovery time after >2 days of administration. (279.8 vs. 138.8 mins) no cases of prolonged neuromuscular block | 10/23 had EMG, 9 of 10 had axonopathy, 8 were sensorimotor Mortality 21% |