2.50
Hdl Handle:
http://hdl.handle.net/10755/158032
Type:
Presentation
Title:
Does Train-of-Four Predict Muscle Movement During NM Blockade in PICU?
Abstract:
Does Train-of-Four Predict Muscle Movement During NM Blockade in PICU?
Conference Sponsor:Western Institute of Nursing
Conference Year:2006
Author:Corso, Lisa, RN, BSN, CCRN
P.I. Institution Name:University of New Mexico Childrens' Hospital
Title:Unit Based Educator
Contact Address:2909 Azar Pl NW, Albuquerque, NM, 87104, USA
Contact Telephone:505-272-2351
Purpose: To study the correlation between train-of-four (TOF) results and spontaneous muscle movement during continuous neuromuscular blockade (NMB) infusion, and after it was discontinued. Background: Long-term use of NMBAs has been linked to prolonged muscle weakness, even after discontinuation of the infusion. Prolonged muscle weakness increases patient ventilator days and ICU stay, which in turn increases healthcare costs. There have not been any studies that conclusively validate the use of TOF to monitor dosing of NMBAs, and few studies focusing on pediatric populations. Minimizing the amount of time on NMBA infusion and the amount of drug given may improve patient recovery after this regime. Design: The study compared TOF results to observed muscle movement during physical care of pediatric patients who required continuous infusion of neuromuscular blockade agents. TOF was tested while on NMB infusion, and at 60 minutes after infusion was discontinued. Method: This was a cohort study of 44 pediatric patients with respiratory, cardiac or other problems. A method-comparison design was used to determine degree of agreement between the 2 stimulation techniques. Outcome measures were determined by clinical observation of muscle movement and train-of-four scores obtained from peripheral nerve stimulation both during and after NMB agent continuous infusion. Analysis was set up so that TOF scores of 0-2 with no muscle movement agreed, and TOF scores of 3-4 with muscle movement agreed.
Results: During infusion, there was no correlation between TOF and muscle movement (Fisher's exact p=1.00). Factors of age, sex, or doses of sedation, analgesia or NMBA were also not significant. At 60 minutes post infusion, TOF predicted movement (p=.002). Length of time on infusion and age were statistically significant. Conclusions: In pediatrics, TOF results are not a good predictor of muscle movement during NMBA infusion. Clinical observation with TOF testing appears to be a more accurate measure of level of paralysis.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleDoes Train-of-Four Predict Muscle Movement During NM Blockade in PICU?en_GB
dc.identifier.urihttp://hdl.handle.net/10755/158032-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Does Train-of-Four Predict Muscle Movement During NM Blockade in PICU?</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Corso, Lisa, RN, BSN, CCRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of New Mexico Childrens' Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Unit Based Educator</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2909 Azar Pl NW, Albuquerque, NM, 87104, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">505-272-2351</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">lcorso@salud.unm.edu</td></tr><tr><td colspan="2" class="item-abstract">Purpose: To study the correlation between train-of-four (TOF) results and spontaneous muscle movement during continuous neuromuscular blockade (NMB) infusion, and after it was discontinued. Background: Long-term use of NMBAs has been linked to prolonged muscle weakness, even after discontinuation of the infusion. Prolonged muscle weakness increases patient ventilator days and ICU stay, which in turn increases healthcare costs. There have not been any studies that conclusively validate the use of TOF to monitor dosing of NMBAs, and few studies focusing on pediatric populations. Minimizing the amount of time on NMBA infusion and the amount of drug given may improve patient recovery after this regime. Design: The study compared TOF results to observed muscle movement during physical care of pediatric patients who required continuous infusion of neuromuscular blockade agents. TOF was tested while on NMB infusion, and at 60 minutes after infusion was discontinued. Method: This was a cohort study of 44 pediatric patients with respiratory, cardiac or other problems. A method-comparison design was used to determine degree of agreement between the 2 stimulation techniques. Outcome measures were determined by clinical observation of muscle movement and train-of-four scores obtained from peripheral nerve stimulation both during and after NMB agent continuous infusion. Analysis was set up so that TOF scores of 0-2 with no muscle movement agreed, and TOF scores of 3-4 with muscle movement agreed. <br/>Results: During infusion, there was no correlation between TOF and muscle movement (Fisher's exact p=1.00). Factors of age, sex, or doses of sedation, analgesia or NMBA were also not significant. At 60 minutes post infusion, TOF predicted movement (p=.002). Length of time on infusion and age were statistically significant. Conclusions: In pediatrics, TOF results are not a good predictor of muscle movement during NMBA infusion. Clinical observation with TOF testing appears to be a more accurate measure of level of paralysis.</td></tr></table>en_GB
dc.date.available2011-10-26T20:26:31Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:26:31Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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