Abstract P-474: NEUROMUSCOLAR BLOCKING AGENTS IN PEDIATRIC INTENSIVE CARE UNITS: A MULTICENTER REPORT OF THE ITALIAN NETWORK OF PEDIATRIC INTENSIVE CARE UNIT STUDY GROUP (TIPNET)

Abstract

Aims & Objectives: In the past 20 years, the use of neuromuscular blocking agents (NMBAs) in pediatric intensive care units (PICUs) is decreased, but still described in mechanically ventilated (MV) patients, often without definite indications. Our aim was to evaluate the NMBAs use and its associated factors in MV children. Methods We performed a retrospective observational multicenter study using a prospective compiled electronic web-based-national registry (TIPNet) of patients admitted to 18 Italians’ PICUs (January 2010-October 2017). We included all MV children (<18 years-of-age) and compared patients who received NMBA (Cur+) with a control group who did not receive this therapy (Cur-). Results A total of 7957 patients were included, 800 (10%) of them were Cur+ (Figure-1). There were no significant differences about race, gender and comorbidities between the two populations. Cur+ patients had a significantly lower age at admission (21months [interquartile range (IQR) 5–69] vs 30months [IQR 7–93],p<0.001), lower weight (10kg [IQR 6–19] vs 12kg [IQR 7–24]),p<0.001), and higher PIM3 (0.02 [IQR 0.01–0.07] vs 0.01 [IQR 0.01–0.04],p< 0.001). Cur+ patients showed longer ventilation duration (4days [IQR 1–10] vs 1day [IQR 0–4],p<0.001) and length of PICU stay (8days [IQR 2–17] vs 3days [IQR 1–9],p<0.001), as well as a significantly higher mortality rate (15%vs 6%,p<0.001). Conclusions A non-negligible proportion of MV children in PICUs received NMBAs. Their use is more frequent in younger age and more critically ill patients. Prolonged MV, longer PICU stay and higher mortality rate were statistically associated. Further studies are needed to clarify the specific indications, patients’ clinical features and the concomitant pharmacological management.