Characterization of Awareness and Depth of Blockade During Neuromuscular Blockade Infusions in Critically Ill...

Area of Science:

• Pediatric Critical Care Medicine
• Neuroscience
• Pharmacology

Background:

• The Society of Critical Care Medicine established guidelines for managing pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients.
• However, recommendations for sedation practices and monitoring during neuromuscular blockade were conditional.

Purpose of the Study:

• To characterize sedation practices in critically ill pediatric patients receiving continuous infusions of neuromuscular blocking agents (NMBAs).
• To assess patient awareness and depth of blockade during NMBA infusion.
• To evaluate adherence to current guidelines in a pediatric cardiac intensive care unit.

Main Methods:

• A retrospective chart review was conducted on critically ill pediatric patients who received continuous infusion NMBAs.
• Data collected included analgosedation agents, doses, and changes, alongside depth of blockade monitoring using Train of Four (TOF) and patient awareness assessed by Richmond Agitation and Sedation Scale (RASS).

Main Results:

• Thirty-one patients were included; 87% had concurrent sedation and 54% received analgesia.
• Rocuronium, dexmedetomidine, and morphine were common agents.
• While RASS scores were recorded for all, 29% had positive scores, indicating inadequate sedation.
• TOF monitoring was documented in only 35% of patients, with most scores indicating either no blockade or deep blockade.

Conclusions:

• Most patients did not receive the recommended depth of blockade monitoring via TOF.
• RASS scores were inconsistent with deep sedation in half of the patients.
• The frequent use of dexmedetomidine as a sole sedative agent raises concerns about current sedation strategies during NMBA infusions.