Continuous skeletal muscle paralysis: effect on neonatal pulmonary mechanics

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Pharmacology

Background:

• Pancuronium bromide is utilized for neuromuscular blockade in neonates requiring mechanical ventilation.
• Its prolonged use in preterm infants with acute respiratory failure is common but its impact on pulmonary mechanics is not well-understood.

Purpose of the Study:

• To evaluate the sequential changes in pulmonary mechanics during and after prolonged pancuronium bromide administration in preterm infants.
• To assess the impact of neuromuscular paralysis on dynamic pulmonary compliance and resistance.

Main Methods:

• Twelve preterm infants with respiratory failure received pancuronium bromide (0.1 mg/kg every 2-3 hours) for over 48 hours.
• Pulmonary compliance, resistance, and work of breathing were measured daily and after drug discontinuation using least mean square analysis.

Main Results:

• Dynamic pulmonary compliance significantly decreased (0.38 to 0.30 mL/cm H2O/kg) during paralysis (P < .05).
• Total pulmonary resistance significantly increased by 51% (115.6 to 174.9 cm H2O/L/s) (P < .005).
• Upon discontinuation, compliance increased 43% and resistance decreased 41% (P < .05 for both).

Conclusions:

• Prolonged pancuronium bromide administration negatively impacts neonatal pulmonary mechanics.
• The findings question the routine use of extended neuromuscular paralysis in neonates and suggest careful consideration of its effects.