From: A fresh look at paralytics in the critically ill: real promise and real concern
NMBA | Author | Subjects | Study design | Motor | Sensory | EMG | Muscle biopsy | Prolonged weakness, CIP, and CIM |
---|---|---|---|---|---|---|---|---|
Benzylisoquinolinium | ||||||||
Cisatracurium | ||||||||
Human studies | ||||||||
Fodale et al. [36] | 1 | Case report | Y | N | Y | N | NMBA and CS for 7 days in patient with chest wall trauma led to quadriplegia consistent with CIM. | |
Davis et al. [35] | 1 | Case report | Y | N | N | N | NMBA and CS for 6 days with 6 additional days of NMBA in 45-year-old with ARDS led to CIM. | |
Atracurium | ||||||||
Human studies | ||||||||
Tousignant et. al. [38] | 1 | Case report | Y | N | Y | N | 18-year-old asthmatic with 7 days of NMBA and CS develops acute quadriparesis 3 days after cessation of NMBA consistent with CIM. | |
Meyer et al. [37] | 2 | Case report | Y | N | Y | N | 38-year-old receiving CS and 8 days of NMBA developed CIM. 25-year-old with good pastures receiving CS and NMBA for 6 days develop CIM. | |
Aminosteriods | ||||||||
Pancuronium | ||||||||
Human studies | ||||||||
Behbehani et al. [26] | 86 | Retrospective Cohort | Y | N | Y | N | Asthmatics receiving NMBA and CS. Pancuronium, vecuronium used in 30 with 9 developing CIM. All nine received pancuronium. | |
de Lemos et al. [39] | 30 | Prospective Observational Cohort | Y | N | Y | N | Study of recovery time in continuous infusion versus bolus groups. Six patients with CIM, five of which received continuous infusion. No statistical difference in total dose between groups. | |
Giostra et al. [30] | 9 | Prospective Cohort | Y | Y | Y | Y | Over 2 years, nine patients with respiratory failure requiring mechanical ventilation and NMBA developed CIP. Eight of nine received concomitant NMBA and CS. | |
Rocuronium | ||||||||
Animal Studies | ||||||||
Maes et al. [40] | Rat / 27 | Prospective Randomize | N/A | N/A | Y | Y | 1 dose of CS added to 24 hours of NMBA results in decreased CIM of diaphragm than NMBA alone. | |
Testelmans et al. [33] | Rat / 24 | Prospective Randomize | N/A | N/A | Y | Y | 24 hours of rocuronium associated with worse CIM than cisatracurium. | |
Testelmans et al. [32] | Rat / 34 | Prospective Randomize | N/A | N/A | Y | Y | 24 hours of NMBA associated with increased CIM than mechanical ventilation alone. | |
Vecuronium | ||||||||
Human Studies | ||||||||
Garnacho- Montero et al. [25] | 73 | Prospective Cohort | Y | Y | Y | N | In septic cohort with more than 2 organ failure, 9 of 10 patients who got NMBA developed CIP. 6 received vecuronium and 3 received atracurium | |
Rudis et al. [34] | 77 | Prospective Randomized Single-Blind | Y | N | Y | N | Use of peripheral nerve stimulator resulted in half dose of NMBA given. 16 patients with prolonged blockade and 4 with CIP. More prolonged blockade and CIP in group with more NMBA. | |
Prielipp et al. [41] | 58 | Prospective Randomized Double-Blind | Y | Y | Y | Y | Prolonged recovery in 13 patients with vecuronuim versus 2 with cisatracurium (p=0.002). CIP in 1 vecuronuim patient. | |
Douglass et al. [27] | 25 | Prospective Cohort | Y | N | N | N | 22 patients received NMBA and CS. 9 developed CIM. CIM associated with time ventilated and dose of NMBA received. | |
Kupfer et al. [31] | 28 | Prospective Cohort | Y | 1/5 | Y | N | 50% of patient without sepsis or multi-organ failure with more than 6 hours of NMBA infusion developed weakness. 1 CIPM, 4 CIM. CIPM and CIM ssociate with increase dose. | |
Danon et al. [42] | 1 | Case report | Y | N | N | Y | 20 year old asthmatic who received CS and NMBA for 10 days developed CIM. |