Characterization of Awareness and Depth of Blockade During Neuromuscular Blockade Infusions in Critically Ill Children.

Q2 Medicine Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-08-01 Epub Date: 2024-08-13 DOI:10.5863/1551-6776-29.4.368
Kelly M Bodine, Elizabeth J Beckman
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Abstract

Objective: The Society of Critical Care Medicine released the first guideline for the prevention and -management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients but offered conditional recommendations for sedation practices and monitoring during neuromuscular blockade. This study aimed to characterize sedation practices, patient awareness, and depth of blockade with neuromuscular blocking agent (NMBA) infusion administration in a single pediatric and cardiac intensive care unit.

Methods: This retrospective chart review of critically ill pediatric patients queried orders for continuous infusion NMBA. Analgosedation agent(s), dose, and dose changes were assessed, along with depth of blockade monitoring via Train of Four (TOF) and awareness via Richmond Agitation and Sedation Scale (RASS).

Results: Thirty-one patients were included, of which 27 (87%) had a documented sedation agent infusing at time of NMBA initiation and 17 patients (54%) were receiving analgesia. The most common agents used were rocuronium (n = 28), dexmedetomidine (n = 23), and morphine (n = 14). RASS scores were captured in all patients; however, 9 patients (29%) had recorded positive scores and 1 patient (3%) never achieved negative scores. TOF was only captured for 11 patients (35%), with majority of the scores being 0 or 4.

Conclusions: Majority of the study population did not receive recommended depth of blockade monitoring via TOF. Similarly, RASS scores were not consistent with deep sedation in half of the patients. The common use of dexmedetomidine as a single sedation agent calls into question the appropriateness of current sedation practices during NMBA continuous infusions.

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重症儿童神经肌肉阻滞输液过程中的意识和阻滞深度特征。
目的:重症医学会发布了第一份儿科重症患者疼痛、躁动、神经肌肉阻滞和谵妄的预防和管理指南,但对神经肌肉阻滞期间的镇静方法和监测提出了有条件的建议。本研究旨在描述一个儿科和心脏重症监护病房在输注神经肌肉阻滞剂(NMBA)时的镇静方法、患者意识和阻滞深度:方法:对儿科重症患者进行回顾性病历审查,查询连续输注 NMBA 的医嘱。评估了镇痛剂、剂量和剂量变化,以及通过四连模(TOF)监测的阻滞深度和通过里士满躁动与镇静量表(RASS)评估的意识:共纳入 31 名患者,其中 27 名患者(87%)在开始使用 NMBA 时使用了记录在案的镇静剂,17 名患者(54%)正在接受镇痛治疗。最常用的镇静剂是罗库洛尼铵(28 人)、右美托咪定(23 人)和吗啡(14 人)。所有患者都获得了 RASS 评分,但有 9 名患者(29%)获得了阳性评分,1 名患者(3%)从未获得过阴性评分。只有 11 名患者(35%)获得了 TOF 分数,其中大部分为 0 分或 4 分:大多数研究对象没有通过 TOF 接受建议的阻滞深度监测。同样,半数患者的 RASS 评分与深度镇静不一致。右美托咪定作为单一镇静剂的普遍使用使人们对目前在 NMBA 连续输注过程中使用镇静剂的适当性产生了质疑。
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来源期刊
Journal of Pediatric Pharmacology and Therapeutics
Journal of Pediatric Pharmacology and Therapeutics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
2.40
自引率
0.00%
发文量
90
期刊介绍: The Journal of Pediatric Pharmacology and Therapeutics is the official journal of the Pediatric Pharmacy Advocacy Group. JPPT is a peer-reviewed multi disciplinary journal that is devoted to promoting the safe and effective use of medications in infants and children. To this end, the journal publishes practical information for all practitioners who provide care to pediatric patients. Each issue includes review articles, original clinical investigations, case reports, editorials, and other information relevant to pediatric medication therapy. The Journal focuses all work on issues related to the practice of pediatric pharmacology and therapeutics. The scope of content includes pharmacotherapy, extemporaneous compounding, dosing, methods of medication administration, medication error prevention, and legislative issues. The Journal will contain original research, review articles, short subjects, case reports, clinical investigations, editorials, and news from such organizations as the Pediatric Pharmacy Advocacy Group, the FDA, the American Academy of Pediatrics, the American Society of Health-System Pharmacists, and so on.
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