Use of peripheral nerve stimulators to monitor patients with neuromuscular blockade in the ICU.
BACKGROUND
Neuromuscular blockade is a frequently used therapy in the ICU. However, recent reports of prolonged paralysis and general muscular weakness in patients treated with this procedure have raised concerns about its use in intensive care.


OBJECTIVE
The purpose of this study was to assess current monitoring practices of nurses who care for patients treated with neuromuscular blockade.


METHODS
In January 1995, questionnaires were mailed to a random national sample of 2000 critical care nurses. Of the 2000 questionnaires mailed, 744 were returned.


RESULTS
The number of patients per month who were treated with neuromuscular blockade in ICU settings ranged from 0 to 75 (mean = 6.82, SD = 9.15). For each patient, the average number of days of blockade ranged from less than 1 to 63 (mean = 4.12, SD = 3.36). The most common indications for neuromuscular blockade were to assist in mechanical ventilation, reduce oxygen consumption, and treat agitation. Only 41% of respondents (n = 306) reported using train-of-four stimuli and a peripheral nerve stimulator to monitor patients. Depth of neuromuscular blockade was routinely monitored by using clinical assessment (31%), a peripheral nerve stimulator (16%), or both (52%).


CONCLUSIONS
Among the respondents, variations existed in monitoring practices and in the use of peripheral nerve stimulators, including the frequency of monitoring and use of the baseline milliamperage. Appropriate monitoring and titration of neuromuscular blocking agents by ICU nurses may aid in preventing adverse effects, including the potential for prolonged neuromuscular blockade. The existing variations in practice may affect patients' outcomes.
Kleinpell
R
R
Rush Presbyterian-St Luke's Medical Center, Chicago, Ill, USA.
Bedrosian
C
C
McCormick
L
L
Kremer
M
M
Bujalski
L
L
Bronsted
R
R
D003422:Critical Care; D016903:Drug Monitoring / Q000379:methods / Q000451:nursing*; D004558:Electric Stimulation / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D008991:Monitoring, Physiologic / Q000379:methods* / Q000706:statistics & numerical data; D019148:Neuromuscular Blockade; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects; D010525:Peripheral Nerves; D011795:Surveys and Questionnaires; D014481:United States
D009466:Neuromuscular Blocking Agents