Efficacy and Safety of Cisatracurium Compared to Vecuronium for Neuromuscular Blockade in Acute Respiratory Distress Syndrome.

PURPOSE: Previous studies analyzing neuromuscular blocking agents (NMBAs) in acute respiratory distress syndrome (ARDS) have evaluated the benefit of cisatracurium with conflicting results, and data evaluating other NMBAs remains limited. The objective of this study was to compare the efficacy and safety of cisatracurium to vecuronium in ARDS. MATERIALS AND METHODS: A single-center, retrospective, propensity matched review of patients who received cisatracurium or vecuronium continuous infusions between October 1, 2017 and June 30, 2020 for ARDS was conducted. The primary endpoint was duration of mechanical ventilation. Secondary endpoints included change in PaO2/FiO2 ratio at 48 h, intensive care unit (ICU) and hospital mortality, and ICU and hospital length of stay (LOS). Safety endpoints included newly developed myopathy, presence of bradycardia or hypotension, and newly developed barotrauma or volutrauma. RESULTS: Twenty-nine patients were included in each group. There was no statistically significant difference in the primary endpoint of ventilator days between cisatracurium and vecuronium groups (mean 15.9 vs. 20.5 days respectively; p = .2). No statistically significant differences were found in secondary endpoints of ICU mortality (51.7% vs. 51.7%) or length of stay (18.7 vs. 23.9 days, p = .19), hospital mortality (51.7% vs. 55.2%, p = .79) or length of stay (22 vs. 30.6 days, p = .08), or mean change in PaO2/FiO2 (29.8 vs. 36.6; p = .74). Statistically significant differences were not observed in safety endpoints of myopathy (37.9% vs. 37.9%), barotrauma or volutrauma (13.8% vs. 3.5%; p = .16), bradycardia (31% vs. 13.8%; p = .12), or hypotension (96.6% vs. 82.8%; p = .08). CONCLUSIONS: No significant differences were seen in efficacy or safety endpoints between cisatracurium or vecuronium groups, suggesting that vecuronium may be a safe alternative agent for neuromuscular blockade in ARDS. Results of this analysis warrant confirmation in a larger, randomized study.

Mapping epistemic cultures and learning potential of participants in citizen science projects.

The ever-widening scope and range of global change and interconnected systemic risks arising from people-environment relationships (social-ecological risks) appears to be increasing concern among, and involvement of, citizens in an increasingly diversified number of citizen science projects responding to these risks. We examined the relationship between epistemic cultures in citizen science projects and learning potential related to matters of concern. We then developed a typology of purposes and a citizen science epistemic-cultures heuristic and mapped 56 projects in southern Africa using this framework. The purpose typology represents the range of knowledge-production purposes, ranging from laboratory science to social learning, whereas the epistemic-cultures typology is a relational representation of scientist and citizen participation and their approach to knowledge production. Results showed an iterative relationship between matters of fact and matters of concern across the projects; the nexus of citizens' engagement in knowledge-production activities varied. The knowledge-production purposes informed and shaped the epistemic cultures of all the sampled citizen science projects, which in turn influenced the potential for learning within each project. Through a historical review of 3 phases in a long-term river health-monitoring project, we found that it is possible to evolve the learning curve of citizen science projects. This evolution involved the development of scientific water monitoring tools, the parallel development of pedagogic practices supporting monitoring activities, and situated engagement around matters of concern within social activism leading to learning-led change. We conclude that such evolutionary processes serve to increase potential for learning and are necessary if citizen science is to contribute to wider restructuring of the epistemic culture of science under conditions of expanding social-ecological risk.