Comparison of fixed dose versus train-of-four titration of cisatracurium in acute respiratory distress syndrome

Melissa L. Thompson Bastin, Rebecca R. Smith, Brittany D. Bissell, Heather N. Wolf, Alexandra M. Wiegand, Megan E. Cavagnini, Yahya Ahmad, Alexander H. Flannery

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Purpose: To compare the ventilatory and clinical outcomes associated with a fixed-dose cisatracurium infusion versus a titrated infusion strategy in patients with Acute Respiratory Distress Syndrome (ARDS). Materials and methods: Single-center, retrospective, cohort study in a medical ICU of a tertiary care academic medical center. Adult patients ≥18 years old with a continuous infusion of cisatracurium for ≥12 h for treatment of ARDS were included. The primary outcome was the PaO2 /FiO2 ratio assessed at 24 and 48 h following cisatracurium initiation. Secondary outcomes included amount of average dose of drug administered, 28-day ventilator-free days, LOS, and hospital mortality. Results: 167 patients were included; median baseline PaO2/FiO2 was 97 (76–146), median SOFA score of 9 (7–11), and ICU mortality was 71/167 (43%). In a mixed-effects model, fixed dose and titrated cisatracurium associated with similar changes in PaO2/FiO2 assessed at 24 and 48 h (p = 0.316). Fixed-dose was associated with a >3-fold increase in drug exposure (average dose 6.4 (5.4–8.0) vs. 2.0 (1.5–2.8) mcg/kg/min; p < 0.001, respectively). No differences were observed in secondary clinical endpoints. Conclusion: Fixed-dose cisatracurium was associated with similar ventilatory and clinical outcomes compared to titrated strategy, yet it was associated with a 3-fold increase in dose administered.

Original languageEnglish
Pages (from-to)86-90
Number of pages5
JournalJournal of Critical Care
StatePublished - Oct 2021

Bibliographical note

Publisher Copyright:
© 2021 Elsevier Inc.


  • ARDS
  • Cisatracurium
  • Critical illness
  • Neuromuscular blockade
  • Paralysis
  • Respiratory distress syndrome

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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