Comparison of train-of-four and best clinical assessment during continuous paralysis
| Autor: | Cheryl Franklin, Leigh Vaughan, Jim Johnson, Charlie Strange |
|---|---|
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Time Factors Demographics Continuous infusion medicine.medical_treatment Critical Care and Intensive Care Medicine law.invention law Intensive care medicine Atracurium besilate Paralysis Humans Prospective Studies Monitoring Physiologic Chemotherapy business.industry Middle Aged Neuromuscular monitoring Intensive care unit Electric Stimulation Surgery Intensive Care Units Anesthesia Atracurium Neuromuscular Blockade Female medicine.symptom business medicine.drug Muscle Contraction Neuromuscular Nondepolarizing Agents |
| Zdroj: | Scopus-Elsevier |
| Popis: | Train-of-four (TOF) monitoring is recommended in published guidelines during use of continuous-infusion neuromuscular blocking agents (NMB) in the intensive care unit (ICU). To test that recommendation, dual protocols were established in a medical ICU after intensive nursing education. Paralyzed patients received either TOF monitoring with a goal of three twitches or best clinical assessment while receiving atracurium by continuous infusion. Demographics and mean duration of paralysis of 20 patients in the TOF group were no different than that of the 16 patients in the best clinical assessment group. Although most patients demonstrated atracurium tolerance over time, there was no difference between groups in total mg (+/- SEM) infused (10,460 +/- 2,409 versus 9,201 +/- 3,237) or mean microgram/kg/min (15.2 +/- 1.5 versus 12.0 +/- 1.1). The time to clinical recovery was no different between groups (50 +/- 10 versus 45 +/- 12 min). Two complications occurred in the TOF group, with pulmonary emboli despite prophylaxis and an unrecognized cerebrovascular accident in one patient each. We conclude that careful titration of NMB using clinical bedside markers should remain the standard of care with these drugs. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|