Agreement between muscle movement and peripheral nerve stimulation in critically ill pediatric patients receiving neuromuscular blocking agents

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• 作者：Olivia Peñ ; a ; Susan Prestjohn ; Cathie E. Guzzetta
• 关键词：myocardial infarction ; exercise cardiac rehabilitation ; exercise facilitation ; self-monitoring
• 刊名：Heart & Lung: The Journal of Acute and Critical Care
• 出版年：2000
• 出版时间：September 2000
• 年：2000
• 卷：29
• 期：5
• 页码：309-318
• 全文大小：64 K

文摘

Objective: The purpose of this study was to determine the degree of agreement between clinically observed muscle movement(s) and train-of-four scores obtained by peripheral nerve stimulation during a neuromuscular blocking agent infusion and after it was discontinued. Design: The study included a method-comparison design. Setting: Subjects were located in the pediatric intensive care unit of a metropolitan children’s hospital. Patients: Study patients included 27 children who required neuromuscular blocking agent infusions. Outcome Measures: Outcome measures were determined by clinical observation of muscle movement and train-of-four scores obtained from peripheral nerve stimulation during and after a neuromuscular blocking agent infusion. Results: Poor agreement was found between observed muscle movement and corresponding train-of-four scores during therapeutic infusions (most κ were less than 0.30), whereas fair to substantial agreement was found between the 2 techniques after the infusion was discontinued (κ ranging from 0.34 to 0.70). Conclusion: Until additional research is available, nurses must titrate the neuromuscular blocking agent infusion on the basis of the clinical endpoints for paralysis in combination with an assessment of the child’s movements and response to peripheral nerve stimulation to prevent overdose and prolonged muscle paralysis. (Heart Lung^® 2000;29:309-18.)