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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
An 84-year-old man developed ICU-acquired weakness during treatment with cisatracurium besilate for continuous muscle paralysis [route, time to reaction onset and outcome not stated].
The man with a medical history of hypertension (treatment with amlodipine) and cerebral infarction was admitted due to virus pneumonia. On admission, he had rapid deterioration of clinical symptoms and laboratory findings. After further investigations, he was diagnosed with acute respiratory distress syndrome (ARDS). Therefore, he received high flow humidified oxygen delivery. However, he had irresistible progression of disease, and he was admitted to the ICU and was started on mechanical ventilation. Due to a serious man-machine confrontation and an urgent need for prone position, he received bolus injection of cisatracurium besilate 0.1 mg/kg to paralyse the muscles on 08 February 2021. Thereafter, a continuous infusion of cisatracurium besilate (median infusion rate of 1.91 µg/kg.minute) was maintained to control the platform pressure under 30 cmH 2O. He received an additional bolus of cisatracurium besilate when plateau airway pressure exceeded 32 cmH 2O to prevent ventilator-associated lung injury. Concomitantly, he received midazolam and remifentanil. After 3 days of mechanical ventilation, he underwent percutaneous tracheotomy. However, he developed ICU-acquired weakness, which was confirmed by two-dimensional ultrasound.The man continued to receive cisatracurium besilate as infusion for more than 720h. Subsequently, he developed deep vein thrombosis twice and clots disappeared on treatment with unspecified low molecular weight heparins. However, his condition deteriorated to pulmonary fibrosis, and 8 eight months after admission, he died due to the his advanced age and severity and complexity of his ARDS.
Reference
- Yuan Z, et al. Continuously protracted infusion of cisatracurium besilate in patients with ARDS. Annals of Medicine and Surgery 77: May 2022. Available from: URL: 10.1016/j.amsu.2022.103718 [DOI] [PMC free article] [PubMed]