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Muscle relaxation in mechanically ventilated infants
The Journal of Pediatrics
|March 1, 1979
Summary
Muscle paralysis using pancuronium in infants on mechanical ventilation showed limited immediate gas exchange improvement but reduced pneumothorax risk. Some infants showed delayed improvement, suggesting pancuronium may benefit select cases.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Mechanical ventilation is crucial for severely ill infants.
- Optimizing gas exchange and minimizing ventilator-induced lung injury are key challenges.
- Muscle paralysis is sometimes used to improve ventilation synchrony.
Purpose of the Study:
- To assess the impact of muscle paralysis on gas exchange and pneumothorax incidence in mechanically ventilated infants.
- To determine if pancuronium improves alveolar-arterial oxygen gradient (AaDO2) and reduces lung injury risk.
Main Methods:
- 35 severely ill infants on mechanical ventilation received pancuronium until spontaneous respirations ceased.
- Gas exchange (AaDO2) and pneumothorax incidence were monitored.
- Infants had inadequate gas exchange or were out of phase with the ventilator.
Main Results:
- Only 2 of 27 infants with high AaDO2 showed immediate improvement (>100 torr).
- By 6 hours, 12 of 27 infants improved, including 5 with prior worsening AaDO2.
- Peak transpulmonary pressures decreased post-paralysis, correlating with a low pneumothorax rate (3/35).
Conclusions:
- Pancuronium offers limited immediate gas exchange benefits but may reduce pneumothorax risk in ventilated infants.
- Delayed gas exchange improvement occurred in some infants, irrespective of baseline characteristics.
- Pancuronium may be considered for ventilated infants with severe lung disease at risk for pneumothorax.