Improved oxygenation after discontinuing neuromuscular blockade

Objective: To evaluate the effects of prolonged neuromuscular blockade (NMB) on oxygenation and duration of mechanical ventilation in children with respiratory failure. Design: Retrospective case control study. Setting: The pediatric intensive care unit (PICU) of a tertiary university hospital. Patients: All children (n=68) in the PICU ventilated for pulmonary parenchymal disease for 3 days or longer over a 412 year period. Interventions: None. Measurements and results: Diagnoses, pediatric risk of mortality scoring, indications for, and duration of, mechanical ventilation and neuromuscular blockade, and blood gas data with corresponding ventilator parameters were extracted from the medical records. Twenty-eight patients received NMB at the initiation of mechanical ventilation and this was continued for 72 h or longer. Cessation of NMB was associated with a significant improvement in ventilator parameters and oxygenation index. The subset of children with respiratory syncytial virus disease (RSV) receiving prolonged NMB had longer ventilator courses compared to those in whom NMB was not used, despite similar demographics, severity of illness and oxygenation impairment. Conclusions: Stopping NMB is associated with a rapid improvement in oxygenation and prolonged use of NMB in children with RSV is associated with a protracted ventilatory course. Definition: Oxygenation index (OI)(*): Mean Airway Pressure ×FiO(2)×100/PaO(2) (*) Higher scores represent deterioration in oxygenation