title: Effect of administration of neuromuscular blocking agents in children with severe traumatic brain injury on acute complication rates and outcomes: a secondary analysis from a randomized, controlled trial of therapeutic hypothermia.
abstract: OBJECTIVE
  To evaluate the association between neuromuscular blocking agents and outcome, intracranial pressure, and medical complications in children with severe traumatic brain injury.
  
  
  METHODS
  A secondary analysis of a randomized, controlled trial of therapeutic hypothermia.
  
  
  METHODS
  Seventeen hospitals in the United States, Australia, and New Zealand.
  
  
  METHODS
  Children (< 18 yr) with severe traumatic brain injury.
  
  
  METHODS
  None for this secondary analysis.
  
  
  RESULTS
  Children received neuromuscular blocking agent on the majority of days of the study (69.6%), and the modified Pediatric Intensity Level of Therapy scores (modified by removing neuromuscular blocking agent administration from the score) were increased on days when neuromuscular blocking agents were used (9.67 ± 0.21 vs 5.48 ± 0.26; p < 0.001). Children were stratified into groups based on exposure to neuromuscular blocking agents (group 1 received neuromuscular blocking agents each study day; group 2 did not). Group 1 had increased number of daily intracranial pressure readings more than 20 mm Hg (4.4 ± 1.1 vs 2.4 ± 0.5;p = 0.015) and longer ICU and hospital length of stay (p = 0.003 and 0.07, respectively, Kaplan-Meier). The Glasgow Outcome Score-Extended for Pediatrics at hospital discharge and 3, 6, and 12 months after traumatic brain injury and medical complications observed during the acute hospitalization were similar between groups.
  
  
  CONCLUSIONS
  Administration of neuromuscular blocking agents was ubiquitous and daily administration of neuromuscular blocking agents was associated with intracranial hypertension but not outcomes-likely indicating that increased injury severity prompted their use. Despite this, neuromuscular blocking agent use was not associated with complications. A different study design-perhaps using randomization or methodologies-of a larger cohort will be required to determine if neuromuscular blocking agent use is helpful after severe traumatic brain injury in children.
authors.affiliation: 1Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. 2Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA. 3Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 4Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA. 5Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA. 6Barrow Neurological Institute of Phoenix Children's Hospital, Phoenix, AZ.
authors.forename: Katherine H
authors.initials: KH
authors.lastname: Chin
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bell
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Goundappa K
authors.initials: GK
authors.lastname: Balasubramani
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kochanek
authors.forename: Sue R
authors.initials: SR
authors.lastname: Beers
authors.forename: S Danielle
authors.initials: SD
authors.lastname: Brown
authors.forename: P David
authors.initials: PD
authors.lastname: Adelson
mesh_terms: D000293:Adolescent; D001315:Australia; D001930:Brain Injuries / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007223:Infant; D015601:Injury Severity Score; D019586:Intracranial Hypertension / Q000209:etiology*; D007427:Intracranial Pressure / Q000187:drug effects; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D009520:New Zealand; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D009466:Neuromuscular Blocking Agents