{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T01:40:29Z","timestamp":1779932429660,"version":"3.53.1"},"reference-count":22,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:00:00Z","timestamp":1702339200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Pharmacy Practice"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:p>Background: Early neuromuscular blockade with cisatracurium has been associated with improved outcomes in moderate-severe acute respiratory distress syndrome (ARDS). Previous studies have demonstrated increased drug utilization without benefits in oxygenation using fixed dose cisatracurium compared to train-of-four (TOF) titration. Objective: We sought to compare a novel, lower fixed dose cisatracurium protocol to TOF titration evaluating the impact on PaO2:FiO2 ratio (P\/F). Methods: We conducted a single-center retrospective cohort study comparing fixed dose cisatracurium to TOF titration. We included patients aged 18-89 treated for COVID-19 ARDS with a baseline P\/F\u2264200 who received a cisatracurium infusion for \u226512\u00a0h. The primary outcome was change in P\/F at 48\u00a0h from baseline. Secondary outcomes included change in P\/F at 24\u00a0h and 7\u00a0days, need for mechanical ventilation at day 28, and cisatracurium utilization. Results: Analyses included 125 patients (fixed dose = 65, TOF = 60). Severe ARDS was common with a baseline median P\/F of 73.7 vs 79.5, P = .133. The change in P\/F at 48\u00a0h was larger in the TOF cohort in the adjusted analysis (24.9 vs 70.8, P &lt; .005). The rate and total cumulative dose of cisatracurium were higher in the fixed dose cohort (5 vs 3 mcg\/kg\/min, P &lt; .001; 1034 vs 612\u00a0mg, P &lt; .001) despite similar infusion durations (44.1\u00a0h vs 48.5\u00a0h, P = .642). Conclusions: Patients in the TOF cisatracurium cohort had improved P\/F at 48\u00a0h compared to the fixed dose cohort, while also using only 60% of the cumulative dose. Future directions should include analysis of the implications of increased cisatracurium exposure on patient outcomes.<\/jats:p>","DOI":"10.1177\/08971900231220438","type":"journal-article","created":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T00:01:20Z","timestamp":1702425680000},"page":"1082-1090","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of Fixed Dosing vs Train of Four Titration of Cisatracurium in COVID-19 ARDS Patients"],"prefix":"10.1177","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5834-8147","authenticated-orcid":false,"given":"Oyshik","family":"Banerjee","sequence":"first","affiliation":[{"name":"Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"Elefritz","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce A.","family":"Doepker","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara A.","family":"Atyia","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, MetroHealth Medical Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan E.","family":"Brummel","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M.","family":"Smith","sequence":"additional","affiliation":[{"name":"Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demond","family":"Handley","sequence":"additional","affiliation":[{"name":"Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9801-3464","authenticated-orcid":false,"given":"Kari M.","family":"Cape","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,12,12]]},"reference":[{"key":"bibr1-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002027"},{"key":"bibr2-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06227-8"},{"key":"bibr3-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000104114.72614.BC"},{"key":"bibr4-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1005372"},{"key":"bibr5-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1901686"},{"key":"bibr6-08971900231220438","volume-title":"Cisatracurium. Package Insert","year":"2021"},{"key":"bibr7-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.4.1267"},{"key":"bibr8-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-017-0234-0"},{"key":"bibr9-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000005174"},{"key":"bibr10-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2021.07.012"},{"key":"bibr11-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2021.05.011"},{"key":"bibr12-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2021.04.028"},{"key":"bibr13-08971900231220438","doi-asserted-by":"publisher","DOI":"10.2147\/JMDH.S330041"},{"key":"bibr14-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1111\/jonm.13648"},{"key":"bibr15-08971900231220438","first-page":"2526","volume":"307","author":"ARDS Definition Task Force","year":"2012","journal-title":"JAMA"},{"key":"bibr16-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201810-2050CP"},{"key":"bibr17-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202106-680OC"},{"key":"bibr18-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"bibr19-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"bibr20-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000001839"},{"key":"bibr21-08971900231220438","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-017-0305-2"},{"key":"bibr22-08971900231220438","volume-title":"Covid-19 Update: Vaccinations Increasing, Delta Variant, Local Efforts Encouraged"}],"container-title":["Journal of Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08971900231220438","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08971900231220438","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08971900231220438","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:38:19Z","timestamp":1777509499000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08971900231220438"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,12]]},"references-count":22,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1177\/08971900231220438"],"URL":"https:\/\/doi.org\/10.1177\/08971900231220438","relation":{},"ISSN":["0897-1900","1531-1937"],"issn-type":[{"value":"0897-1900","type":"print"},{"value":"1531-1937","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,12]]}}}