APPENDIX 4Main Study Findings and Author’s Conclusions
Table A3Summary of Findings of the Systematic Review
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| Main Study Findings and Author’s Conclusions |
|---|
| Warr,7 2011, Canada |
|---|
Main Findings:
Evidence regarding the neuromuscular monitoring with TOF compared to clinical assessment were obtained from three prospective clinical trials (Rudis et al., 1997; Strange et al., 1997; and Baumann et al. 2004). The NMBA used in each trial was different (vecuronium, cisatracurium or atracurium). TOF monitoring showed benefits with respect to reducing the occurrence of prolonged paralysis (defined as recovery that is 50% to 100% longer than predicted by the pharmacological parameters), in the trial where vecuronium was used. This was not observed in the two trials where cisatracurium and atracurium were used and the authors suggested that this may be due to the more predictable elimination of these agents.
Authors’ Conclusions:
“NMBAs are high-alert agents used to manage critically ill patients for compromised gas exchange and ventilation, control of life-threatening intracranial hypertension, and reduction of cerebral metabolism due to shivering during therapeutic hypothermia. To promote patient safety and inform clinical decision making when applying these agents to practice, multidisciplinary ICU team members should be familiar with efficacy data, as well as pharmacology, pharmacokinetics, dosing, drug interactions, required monitoring, and adverse effects. Crucial considerations for optimization of treatment with NMBAs include patient-based selection of the drug, identification and frequent reassessment of treatment goals, titration of the agents to objective parameters (using clinical assessment and TOF monitoring), use of intermittent therapy when possible, implementation of interruption strategies, and daily assessment for the need of continuous therapy.” Page 1123 |
ICU = intensive care unit, NMBA = neuromuscular blocking agent, TOF = train of four
