Prospective documentation of sedative, analgesic, and neuromuscular blocking agent use in infants and children in the intensive care unit: A multicenter perspective.

Abstract

OBJECTIVE: To describe the use of neuromuscular blocking agents (NMBA) in critically ill children. DESIGN: Prospective cohort study. SETTING: Two pediatric intensive care units (ICUs). PATIENTS: All children who received NMBA in the ICUs during the study year. INTERVENTIONS: None Measurements: Data on use of NMBA agents and concurrent use of narcotic and sedative agents were collected. Demographic and outcome information was also obtained. MAIN RESULTS: NMBAs were used for either short-term (<6 hrs) or long-term neuromuscular blockade in 6%-9% of patient ICU days and for long-term blockade in 14%-16% of ventilatory support days. The overall mortality rate among ICU patients who received NMBA was 18%. Choice of agent varied between ICUs; however, succinyl choline was used in only 1% of cases for short-term neuromuscular blockade. The most frequent indication for long-term NMBA use was facilitation of mechanical ventilatory support (49%). Among these children, 46% received high frequency oscillatory ventilation. Long-term neuromuscular blockade was most frequently monitored by clinical examination rather than peripheral nerve stimulation. Paralysis for >6 hrs after discontinuation of NMBA was significantly more common when the agent was administered as an infusion instead of as bolus doses. Myopathy after long-term use of NMBA was seen in only 1 patient (0.4%). Doses (mg/kg) of NMBA did not significantly vary by patient age, but they did increase over time. CONCLUSIONS: Use of NMBA is more common in critically ill children than in reported studies of critically ill adults. Use of NMBA in critically ill children is associated with high severity of illness and mortality rates. Choice of NMBA and method of administration varies among providers. Concurrent use of narcotic and sedative agents with NMBA is frequent, but medication choice also varies among medical providers.