Respiratory failure & ventilation
Two paths to paralysis: A multicenter comparison of cisatracurium to atracurium in the management of acute respiratory distress syndrome
Authors' conclusion
Atracurium and cisatracurium demonstrated similar safety and effectiveness in patients with moderate-to-severe ARDS.
Study context
- Population
- Mechanically ventilated adults with moderate-to-severe acute respiratory distress syndrome (ARDS) (PaO2/FiO2 < 150), 11 Ascension Health hospitals, January 2017–December 2023
- Participants
- 384 participants · 11 hospitals
- Exposure
- Atracurium vs cisatracurium continuous infusion
- Atracuriumn = 192
- Cisatracuriumn = 192reference
- Outcome
- Ventilator-free days
- Follow-up
- Day 28
Methodological detailsmulticentre, matched cohort, multivariable analysis
- Multicentre
- Matched cohort
- Multivariable analysis
Main finding
As reported in the abstract
Did not differ between groups, unmatched cohort (median [IQR]); the abstract does not state which group each value belongs to
0 [IQR 0-16.7] vs. 0 [IQR 0-16.4]
p = 0.72
Did not differ between groups, matched cohort (median [IQR]); the abstract does not state which group each value belongs to
0 [IQR 0-18.3] vs. 0 [IQR 0-14.4]
p = 0.09
Observational data: associations, not effects.
Further findings
90-day inpatient mortality, LOS, duration of mechanical ventilation (matched)
- No significant differences after matching
Improvement in PaO2/FiO2 ratio · 72 h
- Greater improvement with cisatracurium
- P < 0.01
Resolution of ARDS
- Similar between groups
Safety
Safety outcomes
- Comparable between agents
Original publication
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