Use of neuromuscular blocking agents in acute respiratory distress syndrome

Tsai-Nguyen, Ginger; Modrykamien, Ariel

doi:10.1080/08998280.2017.1416237

Cited by 4 publications

(6 citation statements)

References 30 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Observing one to two twitches correlates with 80 to 90% blockade of neuromuscular junctions. 76 We believe if PNS monitoring is used a goal of one to two twitches, in conjunction with a clinical assessment, is a reasonable starting point. A clinical assessment is recommended by SCCM due to variability in muscular response to temperature, peripheral edema, variations in devices, and variability in staff training and experience.…”

Section: Dosing Monitoring and Durationmentioning

confidence: 99%

Role of Pharmacologic Paralysis in Acute Respiratory Distress Syndrome

Syed

Kobzik

Huang

2019

Semin Respir Crit Care Med

View full text Add to dashboard Cite

The pharmacology and history of neuromuscular blockade in clinical care are complex, with multiple theoretical and observed potential benefits and potential harms. Past studies raised concern for long-term paresis, but more recent studies have not found evidence for harm, possibly due to changes in background care, neuromuscular blocking agent, and duration of blockade. Current use is highly variable, likely due to limited evidence for efficacy beyond short-term physiologic improvement and lingering concerns for harm. A recently completed large multicenter trial will provide further information on the role of pharmacologic paralysis in acute respiratory distress syndrome.

show abstract

Section: Dosing Monitoring and Durationmentioning

confidence: 99%

Role of Pharmacologic Paralysis in Acute Respiratory Distress Syndrome

Syed

Kobzik

Huang

2019

Semin Respir Crit Care Med

View full text Add to dashboard Cite

show abstract

“…Considering the bolus and continuous infusion protocols, our group recently published a paper comparing the protocols in mice during normal aging process. 32 We found that the bolus and continuous infusion protocols could differentiate the CPM parameters among different ages with four (30, 100, 300, and 1000 mgÁkg À1 for bolus) and three (48,96, 192 mgÁkg À1 Ámin À1 for continuous infusion) doses of MCh (Table 2). Additionally, the main parameter affected by the aging process was the elastance, and the observed differences were similar in the two protocols.…”

Section: Mch Infusionmentioning

confidence: 92%

“…Neuromuscular blockers (NMBAs) act on nicotinic cholinergic receptors at the neuromuscular junction to impair the transmission of nerve impulses, which result in muscle relaxation. 48 Currently, there are several drugs that belong to the NMBAs class; however, pancuronium, vecuronium, and rocuronium do not seem to interfere with lung function. 49 Routes of administration are generally intravenous and intraperitoneal; doses vary widely.…”

Section: Muscle Blockersmentioning

confidence: 99%

Drug class effects on respiratory mechanics in animal models: access and applications

Oliveira

Lino-Alvarado

Moriya

et al. 2021

Exp Biol Med (Maywood)

View full text Add to dashboard Cite

Assessment of respiratory mechanics extends from basic research and animal modeling to clinical applications in humans. However, to employ the applications in human models, it is desirable and sometimes mandatory to study non-human animals first. To acquire further precise and controlled signals and parameters, the animals studied must be further distant from their spontaneous ventilation. The majority of respiratory mechanics studies use positive pressure ventilation to model the respiratory system. In this scenario, a few drug categories become relevant: anesthetics, muscle blockers, bronchoconstrictors, and bronchodilators. Hence, the main objective of this study is to briefly review and discuss each drug category, and the impact of a drug on the assessment of respiratory mechanics. Before and during the positive pressure ventilation, the experimental animal must be appropriately sedated and anesthetized. The sedation will lower the pain and distress of the studied animal and the plane of anesthesia will prevent the pain. With those drugs, a more controlled procedure is carried out; further, because many anesthetics depress the respiratory system activity, a minimum interference of the animal’s respiration efforts are achieved. The latter phenomenon is related to muscle blockers, which aim to minimize respiratory artifacts that may interfere with forced oscillation techniques. Generally, the respiratory mechanics are studied under appropriate anesthesia and muscle blockage. The application of bronchoconstrictors is prevalent in respiratory mechanics studies. To verify the differences among studied groups, it is often necessary to challenge the respiratory system, for example, by pharmacologically inducing bronchoconstriction. However, the selected bronchoconstrictor, doses, and administration can affect the evaluation of respiratory mechanics. Although not prevalent, studies have applied bronchodilators to return (airway resistance) to the basal state after bronchoconstriction. The drug categories can influence the mathematical modeling of the respiratory system, systemic conditions, and respiratory mechanics outcomes.

show abstract

“…Atracurium is a benzylisoquinolinium non‐depolarizing neuromuscular blocking agent that can be used to improve patient synchrony during mechanical ventilation (MV) 1‐4 . Atracurium is metabolized by both Hofmann elimination, degrading spontaneously at body temperature and pH, and ester hydrolysis by plasma esterases 1‐4 . As metabolism is independent of hepatic and renal function, it is a useful neuromuscular blocking agent in critically ill patients that may have varying degrees of organ dysfunction.…”

Section: Introductionmentioning

confidence: 99%

“…Degradation of atracurium produces laudanosine, which undergoes hepatic metabolism and predominantly renal excretion 1,2 . Laudanosine has been associated with central nervous system excitement and seizures in people 1‐2,4 and its administration has been documented to cause seizures under experimental conditions in dogs at doses of 14‐22 mg/kg 3 . No data are available in animal models that determine the corresponding atracurium dose required to reach these concentrations.…”

Section: Introductionmentioning

confidence: 99%

Seizure activity following atracurium continuous rate infusion in three mechanically ventilated juvenile dogs

Donaldson

Cortellini

Humm

2020

J Vet Emergen Crit Care

View full text Add to dashboard Cite

Objective To describe patient recovery in dogs that had undergone mechanical ventilation (MV) and received atracurium as a continuous rate infusion (CRI). Case series summary Three dogs were treated with atracurium CRI while mechanically ventilated and were successfully weaned. All were pediatric patients (2‐3 months old) ventilated due to respiratory fatigue and hypoxemia. All dogs experienced seizure activity in the initial 24 h following extubation and were treated with various anticonvulsant protocols; no patients experienced documented seizures after 48 h of discontinuation from MV. New or unique information provided All three successfully weaned dogs that had received an atracurium CRI experienced new onset seizures in their recovery from MV. Atracurium use in long‐term MV has not been described previously, and seizures in dogs following atracurium administration has not been described in the clinical setting. Although causation cannot be proven in this case series, atracurium use should be carefully considered and be monitored appropriately when used for a prolonged duration.

show abstract

Use of neuromuscular blocking agents in acute respiratory distress syndrome

Cited by 4 publications

References 30 publications

Role of Pharmacologic Paralysis in Acute Respiratory Distress Syndrome

Role of Pharmacologic Paralysis in Acute Respiratory Distress Syndrome

Drug class effects on respiratory mechanics in animal models: access and applications

Seizure activity following atracurium continuous rate infusion in three mechanically ventilated juvenile dogs

Contact Info

Product

Resources

About