Sedation, Analgesia, and Neuromuscular Blockade: An Assessment of Practices From 2009 to 2016 in a National Sample of 66,443 Pediatric Patients Cared for in the ICU*

BACKGROUND: Neuromuscular blockade is a frequently used therapy in the ICU. However, recent reports of prolonged paralysis and general muscular weakness in patients treated with this procedure have raised concerns about its use in intensive care. OBJECTIVE: The purpose of this study was to assess current monitoring practices of nurses who care for patients treated with neuromuscular blockade. METHODS: In January 1995, questionnaires were mailed to a random national sample of 2000 critical care nurses. Of the 2000 questionnaires mailed, 744 were returned. RESULTS: The number of patients per month who were treated with neuromuscular blockade in ICU settings ranged from 0 to 75 (mean = 6.82, SD = 9.15). For each patient, the average number of days of blockade ranged from less than 1 to 63 (mean = 4.12, SD = 3.36). The most common indications for neuromuscular blockade were to assist in mechanical ventilation, reduce oxygen consumption, and treat agitation. Only 41% of respondents (n = 306) reported using train-of-four stimuli and a peripheral nerve stimulator to monitor patients. Depth of neuromuscular blockade was routinely monitored by using clinical assessment (31%), a peripheral nerve stimulator (16%), or both (52%). CONCLUSIONS: Among the respondents, variations existed in monitoring practices and in the use of peripheral nerve stimulators, including the frequency of monitoring and use of the baseline milliamperage. Appropriate monitoring and titration of neuromuscular blocking agents by ICU nurses may aid in preventing adverse effects, including the potential for prolonged neuromuscular blockade. The existing variations in practice may affect patients' outcomes.

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NEUROMUSCULAR BLOCKADE MONITORING IN PEDIATRIC PATIENTS

AJN American Journal of Nursing ◽

10.1097/00000446-200012000-00026 ◽

2000 ◽

Vol 100 (12) ◽

pp. 24HH

Author(s):

&NA;

Keyword(s):

Neuromuscular Blockade ◽

Pediatric Patients

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Neuromuscular blockade in children

Revista do Hospital das Clínicas ◽

10.1590/s0041-87812000000300007 ◽

2000 ◽

Vol 55 (3) ◽

pp. 105-110 ◽

Cited By ~ 3

Author(s):

João Fernando Lourenço de Almeida ◽

W. Jorge Kalil Filho ◽

Eduardo J. Troster

Keyword(s):

Mechanical Ventilation ◽

Neuromuscular Junction ◽

Neuromuscular Blockade ◽

Continuous Improvement ◽

Pediatric Patients ◽

Invasive Procedure ◽

Medical Intervention ◽

Neuromuscular Blocking ◽

Neuromuscular Blocking Agents ◽

The Many

Neuromuscular blocking agents (NMBAs) have been widely used to control patients who need to be immobilized for some kind of medical intervention, such as an invasive procedure or synchronism with mechanical ventilation. The purpose of this monograph is to review the pharmacology of the NMBAs, to compare the main differences between the neuromuscular junction in neonates, infants, toddlers and adults, and moreover to discuss their indications in critically ill pediatric patients. Continuous improvement of knowledge about NMBAs pharmacology, adverse effects, and the many other remaining unanswered questions about neuromuscular junction and neuromuscular blockade in children is essential for the correct use of these drugs. Therefore, the indication of these agents in pediatrics is determined with extreme judiciousness. Computorized (Medline 1990-2000) and active search of articles were the mechanisms used in this review.

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Nurse performed peripheral intravenous catheter first time insertion success in pediatric patients in Bhutan: An observational study

The Journal of Vascular Access ◽

10.1177/1129729818792826 ◽

2018 ◽

Vol 20 (2) ◽

pp. 184-189 ◽

Cited By ~ 1

Author(s):

Jigme Choden ◽

Peter J Carr ◽

Aleisha R Brock ◽

Adrian Esterman

Keyword(s):

Skin Color ◽

Pediatric Patients ◽

Linear Models ◽

National Sample ◽

Intravenous Catheter ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Peripheral Intravenous Catheter ◽

The Impact ◽

First Time

Introduction: Peripheral intravenous catheter insertion is a clinical procedure commonly performed by nurses for pediatric patients in Bhutan. This study describes peripheral intravenous catheter first attempt success and factors associated with such insertions. Methods: A cross-sectional survey was conducted from October 2016 to March 2017, comprised of a national sample of the Bhutan pediatric patient population (0–12 years). We collected data on peripheral intravenous catheter first time insertion success rate of admitted pediatric patients, to identify predictors of a successful first time attempt. Clustered log binomial generalized linear models were used to obtain the prevalence of first time attempt success and predictors of success. Results: The prevalence rate of successful first time attempt adjusted for clustering was 64% (95% confidence interval: 51%–80%). Predictors of a successful first time attempt were older patient age, lighter skin color, the vein being visible with a tourniquet, and the left hand being used for insertion. A transilluminator was used in 52 patients, and the peripheral intravenous catheter was eventually successfully placed in 82% of the patients. Discussion: Our first time successful cannulation rate is substantially lower than that found in similar studies in other countries. Considering the impact a peripheral intravenous catheter has on patients’ clinical outcomes and cost implications, reducing the number of failed attempts should be of high importance. Better education and simulation, combined with the adoption of vessel locating technology, are required to improve insertion practice in Bhutan. This could lead to greater efficiency of the health facilities in Bhutan.

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Sugammadex: Applications in Pediatric Critical Care

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1705133 ◽

2020 ◽

Vol 09 (03) ◽

pp. 162-171

Author(s):

Joseph D. Tobias

Keyword(s):

Neuromuscular Blockade ◽

Pediatric Patients ◽

Pediatric Population ◽

Acetylcholinesterase Inhibitor ◽

Pediatric Intensive Care ◽

Acetylcholinesterase Inhibitors ◽

Intensive Care Unit Population ◽

Pharmacologic Agent ◽

Complete Reversal ◽

Prospective Trials

AbstractSugammadex is a novel pharmacologic agent, which reverses neuromuscular blockade with a mechanism that differs from acetylcholinesterase inhibitors such as neostigmine. There is a growing body of literature demonstrating its efficacy in pediatric patients of all ages. Prospective trials have demonstrated a more rapid and more complete reversal of rocuronium-induced neuromuscular blockade than the acetylcholinesterase inhibitor, neostigmine. Unlike the acetylcholinesterase inhibitors, sugammadex effectively reverses intense or complete neuromuscular blockade. It may also be effective in situations where reversal of neuromuscular blockade is problematic including patients with neuromyopathic conditions or when acetylcholinesterase inhibitors are contraindicated. This article reviews the physiology of neuromuscular transmission as well as the published literature, regarding the use of sugammadex in pediatric population including the pediatric intensive care unit population. Clinical applications are reviewed, adverse effects are discussed, and dosing algorithms are presented.

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