CHEST SEEK™ Challenge: Which of the following is an important concern regarding cisatracurium infusion in this patient with ARDS?

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You are managing a 45-year-old man with alcoholic cirrhosis and renal failure who has developed ARDS following spontaneous bacterial peritonitis and progressive septic shock. The patient is requiring FIO2 of 0.5 and PEEP of 16 cm H2O to achieve Pao2 of 65 mm Hg. The patient is sedated and is synchronous with the ventilator. You are considering administering the neuromuscular blocking agent cisatracurium by continuous infusion for the next 48 h according to your ICU protocol. Which of the following statements is an important concern regarding cisatracurium infusion in this patient with ARDS?

A. The parent compound, cisatracurium, will accumulate in the setting of advanced liver failure, producing prolonged paralysis.

B. Cisatracurium is metabolized to an active compound that accumulates and produces prolonged paralysis in renal failure.

C. In the large, multicenter, randomized placebo-controlled trials to date, cisatracurium was consistently associated with prolonged weakness during recovery.

D. In the large, multicenter, randomized placebo-controlled trials to date, cisatracurium was not consistently associated with lower mortality or more ventilator-free days.