title: Agreement between muscle movement and peripheral nerve stimulation in critically ill pediatric patients receiving neuromuscular blocking agents.
abstract: 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.
  
  
  METHODS
  The study included a method-comparison design.
  
  
  METHODS
  Subjects were located in the pediatric intensive care unit of a metropolitan children's hospital.
  
  
  METHODS
  Study patients included 27 children who required neuromuscular blocking agent infusions.
  
  
  METHODS
  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 kappa were less than 0.30), whereas fair to substantial agreement was found between the 2 techniques after the infusion was discontinued (kappa ranging from 0.34 to 0.70).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Children's Medical Center of Dallas, Texas, USA.
authors.forename: O
authors.initials: O
authors.lastname: Peña
authors.forename: S
authors.initials: S
authors.lastname: Prestjohn
authors.forename: C E
authors.initials: CE
authors.lastname: Guzzetta
mesh_terms: D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D008991:Monitoring, Physiologic; D018482:Muscle, Skeletal / Q000502:physiology*; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage*; D010525:Peripheral Nerves / Q000502:physiology; D010865:Pilot Projects; D011446:Prospective Studies; D014673:Vecuronium Bromide / Q000008:administration & dosage
chemical_list: D009466:Neuromuscular Blocking Agents; D001279:Atracurium; D014673:Vecuronium Bromide; C101584:cisatracurium