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Matthias Eikermann - One of the best experts on this subject based on the ideXlab platform.

  • optimal sedation in patients who receive Neuromuscular Blocking agent infusions for treatment of acute respiratory distress syndrome a retrospective cohort study from a new england health care network
    Critical Care Medicine, 2021
    Co-Authors: Karuna Wongtangman, Stephanie D Grabitz, Maximilian Hammer, Luca J Wachtendorf, Maximilian S Schaefer, Philipp Fassbender, Peter Santer, Elias Baedorf Kassis, Daniel Talmor, Matthias Eikermann
    Abstract:

    OBJECTIVES Two previously published trials (ARDS et Curarisation Systematique [ACURASYS] and Reevaluation of Systemic Early Neuromuscular Blockade [ROSE]) presented equivocal evidence on the effect of Neuromuscular Blocking agent infusions in patients with acute respiratory distress syndrome (acute respiratory distress syndrome). The sedation regimen differed between these trials and also within the ROSE trial between treatment and control groups. We hypothesized that the proportion of deeper sedation is a mediator of the effect of Neuromuscular Blocking agent infusions on mortality. DESIGN Retrospective cohort study. SETTING Seven ICUs in an academic hospital network, Beth Israel Deaconess Medical Center (Boston, MA). PATIENTS Intubated and mechanically ventilated ICU patients with acute respiratory distress syndrome (Berlin definition) admitted between January 2008 until June 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The proportion of deeper sedation was defined as days with nonlight sedation as a fraction of mechanical ventilation days in the ICU after acute respiratory distress syndrome diagnosis. Using clinical data obtained from a hospital network registry, 3,419 patients with acute respiratory distress syndrome were included, of whom 577 (16.9%) were treated with Neuromuscular Blocking agent infusions, for a mean (SD) duration of 1.8 (±1.9) days. The duration of deeper sedation was prolonged in patients receiving Neuromuscular Blocking agent infusions (4.6 ± 2.2 d) compared with patients without Neuromuscular Blocking agent infusions (2.4 ± 2.2 d; p < 0.001). The proportion of deeper sedation completely mediated the negative effect of Neuromuscular Blocking agent infusions on in-hospital mortality (p < 0.001). Exploratory analysis in patients who received deeper sedation revealed a beneficial effect of Neuromuscular Blocking agent infusions on mortality (49% vs 51%; adjusted odds ratio, 0.80; 95% CI, 0.63-0.99, adjusted absolute risk difference, -0.05; p = 0.048). CONCLUSIONS In acute respiratory distress syndrome patients who receive Neuromuscular Blocking agent infusions, a prolonged, high proportion of deeper sedation is associated with increased mortality. Our data support the view that clinicians should minimize the duration of deeper sedation after recovery from Neuromuscular Blocking agent infusion.

  • dose dependent association between intermediate acting Neuromuscular Blocking agents and postoperative respiratory complications
    Anesthesiology, 2015
    Co-Authors: Duncan Mclean, Matthias Eikermann, Tobias Kurth, Daniel Diazgil, Hassan Farhan, Karim S Ladha
    Abstract:

    Background:Duration of action increases with repeated administration of Neuromuscular-Blocking agents, and intraoperative use of high doses of Neuromuscular-Blocking agent may affect respiratory safety.Methods:In a hospital-based registry study on 48,499 patients who received intermediate-acting neu

  • calabadion a new agent to reverse the effects of benzylisoquinoline and steroidal Neuromuscular Blocking agents
    Anesthesiology, 2013
    Co-Authors: Ulrike Hoffmann, Martina Grossesundrup, Katharina Eikermannhaerter, Cenk Ayata, Ben Zhang, S Zaremba, Lyle Isaacs, Matthias Eikermann
    Abstract:

    To evaluate whether calabadion 1, an acyclic member of the Cucurbit[n]uril family of molecular containers, reverses benzylisoquinoline and steroidal Neuromuscular-Blocking agent effects.A total of 60 rats were anesthetized, tracheotomized, and instrumented with IV and arterial catheters. Rocuronium (3.5 mg/kg) or cisatracurium (0.6 mg/kg) was administered and Neuromuscular transmission quantified by acceleromyography. Calabadion 1 at 30, 60, and 90 mg/kg (for rocuronium) or 90, 120, and 150 mg/kg (for cisatracurium), or neostigmine/glycopyrrolate at 0.06/0.012 mg/kg were administered at maximum twitch depression, and renal calabadion 1 elimination was determined by using a H NMR assay. The authors also measured heart rate, arterial blood gas parameters, and arterial blood pressure.After the administration of rocuronium, resumption of spontaneous breathing and recovery of train-of-four ratio to 0.9 were accelerated from 12.3 ± 1.1 and 16.2 ± 3.3 min with placebo to 4.6 ± 1.8 min with neostigmine/glycopyrrolate to 15 ± 8 and 84 ± 33 s with calabadion 1 (90 mg/kg), respectively. After the administration of cisatracurium, recovery of breathing and train-of-four ratio of 0.9 were accelerated from 8.7 ± 2.8 and 9.9 ± 1.7 min with placebo to 2.8 ± 0.8 and 7.6 ± 2.1 min with neostigmine/glycopyrrolate to 47 ± 13 and 87 ± 16 s with calabadion 1 (150 mg/kg), respectively. Calabadion 1 did not affect heart rate, mean arterial blood pressure, pH, carbon dioxide pressure, and oxygen tension. More than 90% of the IV administered calabadion 1 appeared in the urine within 1 h.Calabadion 1 is a new drug for rapid and complete reversal of the effects of steroidal and benzylisoquinoline Neuromuscular-Blocking agents.

  • Neuromuscular Blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure related complications
    Critical Care Medicine, 2012
    Co-Authors: Susan R Wilcox, Matthias Eikermann, Nicole Thuy P Nguyen, Edward A Bittner, Jonathan Elmer, Todd A Seigel, Anahat Dhillon, Ulrich Schmidt
    Abstract:

    Background:Emergent intubation is associated with a high rate of complications. Neuromuscular Blocking agents are routinely used in the operating room and emergency department to facilitate intubation. However, use of Neuromuscular Blocking agents during emergent airway management outside of the ope

  • Neuromuscular Blocking agents for electroconvulsive therapy a systematic review
    Acta Anaesthesiologica Scandinavica, 2012
    Co-Authors: Hooman Mirzakhani, Charles A. Welch, Matthias Eikermann, Ala Nozari
    Abstract:

    Electroconvulsive therapy (ECT) is the transcutaneous application of small electrical stimuli to the brain to induce generalised seizures for the treatment of selected psychiatric disorders. The clinical indications for ECT as an effective therapeutic modality have been considerably expanded since its introduction. Anaesthesia and Neuromuscular Blocking agents (NMBAs) are required to ensure patients’ safety during ECT. The optimal dose of muscle relaxant for ECT reduces muscle contractions without inducing complete paralysis. Slight residual motor convulsive activity is helpful in ascertaining that a seizure has occurred, while total paralysis prolongs the procedure unnecessarily. Suxamethonium is commonly used, but nondepolarising NMBAs are indicated in patients with certain comorbidities. In this review, we summarise current concepts of NMBA management for ECT.

J Vibymogensen - One of the best experts on this subject based on the ideXlab platform.

  • good clinical research practice in pharmacodynamic studies of Neuromuscular Blocking agents ii the stockholm revision
    Acta Anaesthesiologica Scandinavica, 2007
    Co-Authors: T Fuchsbuder, L I Eriksson, L T Skovgaard, C Claudius, R K Mirakhur, J Vibymogensen
    Abstract:

    The set of guidelines for good clinical research practice (GCRP) in pharmacodynamic studies of Neuromuscular Blocking agents, which was developed following an international consensus conference in Copenhagen, has been revised and updated following the second consensus conference in Stockholm in 2005. It is hoped that these guidelines will continue to help researchers in the field and assist the pharmaceutical industry and equipment manufacturers in enhancing the standards of the studies they sponsor.

  • pharmacokinetic studies of Neuromuscular Blocking agents good clinical research practice gcrp
    Acta Anaesthesiologica Scandinavica, 2000
    Co-Authors: J Vibymogensen, Johannes H Proost, J. M. Hunter, D Ostergaard, F Donati, D Fisher, J P Kampmann, A Kopman, S N Rasmussen, L T Skovgaard
    Abstract:

    In September 1997, an international consensus conference on standardization of studies of Neuromuscular Blocking agents was held in Copenhagen, Denmark. Based on the conference, a set of guidelines for good clinical research practice (GCRP) in pharmacokinetic studies of Neuromuscular Blocking agents is presented. Guidelines include: design of the study; relevant patient groups to investigate; test drug administration, sampling and analysis; pharmacokinetic analysis; pharmacokinetic/pharmacodynamic modeling; population pharmacokinetics; statistics; and presentation of pharmacokinetic data. The guidelines are intended to aid those working in this research area; it is hoped that they will assist researchers, editors of scientific papers, and pharmaceutical companies in improving the quality of pharmacokinetic studies.

  • good clinical research practice gcrp in pharmacodynamic studies of Neuromuscular Blocking agents
    Acta Anaesthesiologica Scandinavica, 1996
    Co-Authors: J Vibymogensen, J Engbaek, L I Eriksson, L Gramstad, E W Jensen, F S Jensen, Z Koscielniaknielsen, L T Skovgaard, D Ostergaard
    Abstract:

    Based on an international consensus conference held in Copenhagen in the autumn of 1994, a set of guidelines for Good Clinical Research Practice (GCRP) in pharmacodynamic studies of Neuromuscular Blocking agents are presented. The guidelines are intended to be a help for people working in this research field, and it is hoped that the guidelines will assist researchers, editors, and drug companies to enhance the quality of their pharmacodynamic studies of Neuromuscular Blocking agents.

L T Skovgaard - One of the best experts on this subject based on the ideXlab platform.

  • good clinical research practice in pharmacodynamic studies of Neuromuscular Blocking agents ii the stockholm revision
    Acta Anaesthesiologica Scandinavica, 2007
    Co-Authors: T Fuchsbuder, L I Eriksson, L T Skovgaard, C Claudius, R K Mirakhur, J Vibymogensen
    Abstract:

    The set of guidelines for good clinical research practice (GCRP) in pharmacodynamic studies of Neuromuscular Blocking agents, which was developed following an international consensus conference in Copenhagen, has been revised and updated following the second consensus conference in Stockholm in 2005. It is hoped that these guidelines will continue to help researchers in the field and assist the pharmaceutical industry and equipment manufacturers in enhancing the standards of the studies they sponsor.

  • pharmacokinetic studies of Neuromuscular Blocking agents good clinical research practice gcrp
    Acta Anaesthesiologica Scandinavica, 2000
    Co-Authors: J Vibymogensen, Johannes H Proost, J. M. Hunter, D Ostergaard, F Donati, D Fisher, J P Kampmann, A Kopman, S N Rasmussen, L T Skovgaard
    Abstract:

    In September 1997, an international consensus conference on standardization of studies of Neuromuscular Blocking agents was held in Copenhagen, Denmark. Based on the conference, a set of guidelines for good clinical research practice (GCRP) in pharmacokinetic studies of Neuromuscular Blocking agents is presented. Guidelines include: design of the study; relevant patient groups to investigate; test drug administration, sampling and analysis; pharmacokinetic analysis; pharmacokinetic/pharmacodynamic modeling; population pharmacokinetics; statistics; and presentation of pharmacokinetic data. The guidelines are intended to aid those working in this research area; it is hoped that they will assist researchers, editors of scientific papers, and pharmaceutical companies in improving the quality of pharmacokinetic studies.

  • good clinical research practice gcrp in pharmacodynamic studies of Neuromuscular Blocking agents
    Acta Anaesthesiologica Scandinavica, 1996
    Co-Authors: J Vibymogensen, J Engbaek, L I Eriksson, L Gramstad, E W Jensen, F S Jensen, Z Koscielniaknielsen, L T Skovgaard, D Ostergaard
    Abstract:

    Based on an international consensus conference held in Copenhagen in the autumn of 1994, a set of guidelines for Good Clinical Research Practice (GCRP) in pharmacodynamic studies of Neuromuscular Blocking agents are presented. The guidelines are intended to be a help for people working in this research field, and it is hoped that the guidelines will assist researchers, editors, and drug companies to enhance the quality of their pharmacodynamic studies of Neuromuscular Blocking agents.

Laurent Papazian - One of the best experts on this subject based on the ideXlab platform.

  • pharmacological interventions Neuromuscular Blocking agents
    2017
    Co-Authors: Samuel Lehingue, Sami Hraiech, Laurent Papazian
    Abstract:

    Neuromuscular Blocking agents (NMBAs) are extensively used in patients who present with acute respiratory distress syndrome (ARDS). The role of NMBAs has been extensively discussed in the past, primarily due to their potential adverse effects and the absence of clear evidence regarding their influence on prognosis. However, recent data have demonstrated that NMBAs are associated with a reduction in mortality in the most severe patients. Currently, the role of paralytics in the care of ARDS patients is proven. The positive effects of paralytics are probably due to the facilitation of protective ventilation, the prevention of ventilator-induced lung injury and the limitation of derecruitment. However, the role of NMBAs should be limited to severe and most hypoxaemic forms of moderate ARDS. NMBAs probably have a crucial role to play in the acute phase of ARDS, i.e. during the climax of lung injury, especially in association with other therapies, such as prone positioning. The use of NMBAs should always be integrated into the overall management strategy for the mechanical ventilation of ARDS patients, and NMBAs should be discontinued as soon as the patient improves sufficiently to allow for partial spontaneous breathing.

  • Neuromuscular Blocking agents in acute respiratory distress syndrome a systematic review and meta analysis of randomized controlled trials
    Critical Care, 2013
    Co-Authors: Waleed Alhazzani, Jeanmarie Forel, Laurent Papazian, Mohamed Alshahrani, Roman Jaeschke, Jonathan E Sevransky, Maureen O Meade
    Abstract:

    Introduction Randomized trials investigating Neuromuscular Blocking agents in adult acute respiratory distress syndrome (ARDS) have been inconclusive about effects on mortality, which is very high in this population. Uncertainty also exists about the associated risk of ICU-acquired weakness.

  • Neuromuscular Blocking agents in acute respiratory distress syndrome a systematic review and meta analysis of randomized controlled trials
    Critical Care, 2013
    Co-Authors: Waleed Alhazzani, Jeanmarie Forel, Laurent Papazian, Mohamed Alshahrani, Roman Jaeschke, Jonathan E Sevransky, Maureen O Meade
    Abstract:

    Randomized trials investigating Neuromuscular Blocking agents in adult acute respiratory distress syndrome (ARDS) have been inconclusive about effects on mortality, which is very high in this population. Uncertainty also exists about the associated risk of ICU-acquired weakness. We conducted a systematic review and meta-analysis. We searched the Cochrane (Central) database, MEDLINE, EMBASE, ACP Journal Club, and clinical trial registries for randomized trials investigating survival effects of Neuromuscular Blocking agents in adults with ARDS. Two independent reviewers abstracted data and assessed methodologic quality. Primary study investigators provided additional unpublished data. Three trials (431 patients; 20 centers; all from the same research group in France) met inclusion criteria for this review. All trials assessed 48-hour infusions of cisatracurium besylate. Short-term infusion of cisatracurium besylate was associated with lower hospital mortality (RR, 0.72; 95% CI, 0.58 to 0.91; P = 0.005; I2 = 0). This finding was robust on sensitivity analyses. Neuromuscular blockade was also associated with lower risk of barotrauma (RR, 0.43; 95% CI, 0.20 to 0.90; P = 0.02; I2 = 0), but had no effect on the duration of mechanical ventilation among survivors (MD, 0.25 days; 95% CI, 5.48 to 5.99; P = 0.93; I2 = 49%), or the risk of ICU-acquired weakness (RR, 1.08; 95% CI, 0.83 to 1.41; P = 0.57; I2 = 0). Primary studies lacked protracted measurements of weakness. Short-term infusion of cisatracurium besylate reduces hospital mortality and barotrauma and does not appear to increase ICU-acquired weakness for critically ill adults with ARDS.

  • Neuromuscular Blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome
    Critical Care Medicine, 2006
    Co-Authors: Jeanmarie Forel, Antoine Roch, Valerie Marin, Pierre Michelet, Didier Demory, Jeanlouis Blache, G Perrin, Marc Gainnier, Pierre Bongrand, Laurent Papazian
    Abstract:

    Objective:To evaluate the effects of Neuromuscular Blocking agents (NMBAs) on pulmonary and systemic inflammation in patients with acute respiratory distress syndrome ventilated with a lung-protective strategy.Design:Multiple-center, prospective, controlled, and randomized trial.Setting:One medical

  • effect of Neuromuscular Blocking agents on gas exchange in patients presenting with acute respiratory distress syndrome
    Critical Care Medicine, 2004
    Co-Authors: Marc Gainnier, Jeanmarie Forel, Antoine Roch, X Thirion, Jeanmichel Arnal, Stephane Donati, Laurent Papazian
    Abstract:

    ObjectiveTo evaluate the effects of a 48-hr Neuromuscular Blocking agents (NMBA) infusion on gas exchange over a 120-hr time period in patients with acute respiratory distress syndrome.DesignMultiple center, prospective, controlled, and randomized trial.SettingFour adult medical or mixed medical-sur

Maureen O Meade - One of the best experts on this subject based on the ideXlab platform.

  • Neuromuscular Blocking agents in acute respiratory distress syndrome a systematic review and meta analysis of randomized controlled trials
    Critical Care, 2013
    Co-Authors: Waleed Alhazzani, Jeanmarie Forel, Laurent Papazian, Mohamed Alshahrani, Roman Jaeschke, Jonathan E Sevransky, Maureen O Meade
    Abstract:

    Randomized trials investigating Neuromuscular Blocking agents in adult acute respiratory distress syndrome (ARDS) have been inconclusive about effects on mortality, which is very high in this population. Uncertainty also exists about the associated risk of ICU-acquired weakness. We conducted a systematic review and meta-analysis. We searched the Cochrane (Central) database, MEDLINE, EMBASE, ACP Journal Club, and clinical trial registries for randomized trials investigating survival effects of Neuromuscular Blocking agents in adults with ARDS. Two independent reviewers abstracted data and assessed methodologic quality. Primary study investigators provided additional unpublished data. Three trials (431 patients; 20 centers; all from the same research group in France) met inclusion criteria for this review. All trials assessed 48-hour infusions of cisatracurium besylate. Short-term infusion of cisatracurium besylate was associated with lower hospital mortality (RR, 0.72; 95% CI, 0.58 to 0.91; P = 0.005; I2 = 0). This finding was robust on sensitivity analyses. Neuromuscular blockade was also associated with lower risk of barotrauma (RR, 0.43; 95% CI, 0.20 to 0.90; P = 0.02; I2 = 0), but had no effect on the duration of mechanical ventilation among survivors (MD, 0.25 days; 95% CI, 5.48 to 5.99; P = 0.93; I2 = 49%), or the risk of ICU-acquired weakness (RR, 1.08; 95% CI, 0.83 to 1.41; P = 0.57; I2 = 0). Primary studies lacked protracted measurements of weakness. Short-term infusion of cisatracurium besylate reduces hospital mortality and barotrauma and does not appear to increase ICU-acquired weakness for critically ill adults with ARDS.

  • Neuromuscular Blocking agents in acute respiratory distress syndrome a systematic review and meta analysis of randomized controlled trials
    Critical Care, 2013
    Co-Authors: Waleed Alhazzani, Jeanmarie Forel, Laurent Papazian, Mohamed Alshahrani, Roman Jaeschke, Jonathan E Sevransky, Maureen O Meade
    Abstract:

    Introduction Randomized trials investigating Neuromuscular Blocking agents in adult acute respiratory distress syndrome (ARDS) have been inconclusive about effects on mortality, which is very high in this population. Uncertainty also exists about the associated risk of ICU-acquired weakness.

  • canadian survey of the use of sedatives analgesics and Neuromuscular Blocking agents in critically ill patients
    Critical Care Medicine, 2006
    Co-Authors: Sangeeta Mehta, Lisa Burry, Sandra Fischer, Carlos J Martinezmotta, David Hallett, Dennis J Bowman, Cindy Wong, Maureen O Meade, Thomas E Stewart, Deborah J Cook
    Abstract:

    Objectives:To characterize the perceived utilization of sedative, analgesic, and Neuromuscular Blocking agents, the use of sedation scales, algorithms, and daily sedative interruption in mechanically ventilated adults, and to define clinical factors that influence these practices.Design:Cross-sectio