• Julie N DiBridge, Ryan M Rivosecchi, Bryan J McVerry, Phillip E Lamberty, Michael P Donahoe, and Lara M Groetzinger.
• Department of Pharmacy, University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop St., Pittsburgh, PA 15213, USA. Electronic address: Dibridgejn2@upmc.edu.
• J Crit Care. 2021 Dec 1; 66: 166172166-172.

PurposeThree continuous dosing strategies of cisatracurium (CIS) for acute respiratory distress syndrome (ARDS) have been described in the literature. After implementation of a ventilator synchrony protocol (VSP), we sought to determine which continuous CIS dosing strategy utilized the least amount of drug without compromising efficacy.MethodsWe retrospectively reviewed patients with ARDS receiving continuous CIS from January 1, 2013 to December 31, 2018. We categorized patients into one of three dosing strategies: fixed dose (FD), titration based solely on train-of-four (TOF), or the VSP. We documented drug consumption and determined efficacy by comparing the change in PaO2/FiO2 ratio (P/F) and oxygenation index (OI) from baseline up to 48 h.ResultsA total of 1047 patients were screened, and 189 met inclusion criteria (VSP = 69, TOF = 99, FD = 21). Drug consumption (mg) was significantly lower in the VSP arm: 415 [IQR 318-528] compared to both the TOF: 665 [IQR 472-927] and the FD arms: 1730 [IQR 1695-1800], p < 0.001 for each. The change in P/F and OI from baseline were statistically equivalent at all time points.ConclusionWithout impacting efficacy of gas exchange, a protocol using ventilator synchrony for CIS titration required significantly less drug compared to TOF-based titration and a fixed dosing regimen.Copyright © 2021 Elsevier Inc. All rights reserved.

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