Author Of 2 Presentations
THE USE OF NEUROMUSCULAR BLOCKING AGENTS IS ASSOCIATED WITH A HIGHER MORTALITY RATE IN PATIENTS ADMITTED TO PEDIATRIC INTENSIVE CARE: A MULTICENTER REPORT
Abstract
Background
Few data are available about patients receiving neuromuscular blocking agents (NMBAs) in pediatric intensive care units (PICU). Their use is often reported without clear and definite indications with conflicting data about the outcome of these patients.
Objectives
To describe the characteristics and outcome of children receiving prolonged NMBAs treatment in PICU.
Methods
Retrospective, multicenter study using a prospective electronic web-based-national-registry (Pediatric Intensive Care Unit Study Group Network-TIPNET) of patients admitted to 18 Italians’ PICUs (January 2010-October 2017). We included children (<18 years-of-age) receiving mechanical ventilation (MV) and compared patients who received NMBAs (Cur+) with children who did not receive them (Cur-).
Results
A total of 3848 patients were included, 504 (13%) Cur+. There were no significant differences about gender, comorbidities and PIM3 score between the two populations. Cur+ had a significantly lower age (20months [interquartile range (IQR) 5-65] vs 30months [IQR 8-83],p<0.001) and weight (10kg [IQR 5-18] vs 12kg [IQR 7-21]),p<0.001). They received MV more for respiratory (50%vs29%,p<0.001) and less for cardiac diseases (10%vs31%,p<0.001). Cur+ showed longer ventilation duration (6days [IQR 2-12] vs 3days [IQR 1-6],p<0.001) and a higher rate of use of high frequency oscillatory ventilation (18%vs3%,p<0.001). A logistic regression adjusted for age, gender and ventilation modality demonstrated a correlation between NMBAs use and mortality (p<0.001).
Conclusion
A non-negligible proportion of children in PICUs received NMBAs. Their use was more frequent in younger age, it is associated with prolonged use of MV and a higher mortality. Further studies are needed to clarify the specific indications, patients’ clinical features and the concomitant pharmacological management.