Effect of neuromuscular blockade on oxygen consumption and energy expenditure in sedated, mechanically ventilated children

Vernon, Donald D.; Witte, Madolin K.

doi:10.1097/00003246-200005000-00051

Cited by 103 publications

(53 citation statements)

References 15 publications

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“…We observed a number of factors, as seen in We also acknowledge a final limitation of our study being that neither the individual's race nor his or her sedation level was taken into account, affecting the resting energy state of our population. 34,35 Our study demonstrates that a statistically …”

Section: Discussionmentioning

confidence: 55%

Factors That Influence the Agreement in Energy Expenditure Assessment in Pediatric Intensive Care Patients

Rzepecki¹,

Andrews²,

Wines³

et al. 2016

Michigan Journal of Medicine

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Section: Discussionmentioning

confidence: 55%

Factors That Influence the Agreement in Energy Expenditure Assessment in Pediatric Intensive Care Patients

Rzepecki¹,

Andrews²,

Wines³

et al. 2016

Michigan Journal of Medicine

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“…NMB ajanların ET ve VO 2 üzerine etkisini indirekt kalorimetri yöntemi kullanarak araştıran bir çalışmada pediatrik yoğun bakımda mekanik ventilatör desteğinde 20 hasta çalışmaya alınmıştır (11) . Midazolam ve/veya fentanil ile sedatize izlenen hastalarda NMB uygulanmasından sonra VO2'de %8,7 , ET'de %10,3'lük (p<0,05) bir azalma saptanmıştır.…”

Section: Discussionunclassified

Mekanik Ventilasyon Uygulanan Akut Solunum Yetmezlikli Hastalarda Nöromüsküler Blokajın Oksijen ve Enerji Tüketimine Etkisi

Yüksel

Çankayalı

Demırağ

et al. 2012

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Amaç: Bu çalışmanın amacı akut solunum yetmezliği tanılı mekanik ventilatör desteği altında sedatize izlenen hastalarda nöromüsküler blokajın oksijen ve enerji tüketimi üzerindeki etkisini araştırmaktır. Gereç ve Yöntem: Akut solunum yetmezliği tanısı ile mekanik ventilasyon desteği uygulanan 21 hasta çalışmaya dahil edildi. Bütün hastalara Ramsay sedasyon skalası 3 olacak şekilde propofol infüzyonu uygulandı.Yeterli sedasyon ve hemodinamik stabilitenin sağlanmasının ardından tüm hastaların oksijen tüketimi, karbondioksit üretimi ve enerji tüketimine ait bazal değerler indirekt kalorimetri cihazı ile ölçüldü ve kaydedildi. Nöromüsküler ileti TOF-Guard ile monitörize edildikten sonra hastalara 0,1 mg/kg bolus doz vekuronyum uygulandı. Oksijen, karbondioksit ve enerji tüketimi değerleri TOF 0, 25, 50, 90 olduğunda indirekt kalorimetri cihazı ile ölçülerek kaydedildi. Bulgular: Hastaların kürarizasyon öncesi ve sonrası hemodinamik parametreleri, ventilasyon parametreleri, arteriyel kan gazı değerleri arasında istatistiksel olarak anlamlı bir fark saptanmadı (p>0,05). Kürarizasyon öncesi (bazal değer) ve TOF 0 iken ölçülen oksijen tüketimi, karbondioksit üretimi ve enerji tüketimi değerleri arasında istatistiksel olarak anlamlı bir azalma gözlendi (p<0,05). Ancak TOF 25, 50, 90 değerlerleri ile bazal değer arasında anlamlı bir değişiklik saptanmadı (p>0,05). ÖZET SUMMARYObjective: The aim of this study is to investigate the effect of neuromuscular blockade on oxygen consumption and energy expenditure in sedated patients with acute respiratory failure who were followed under mechanical ventilation support. Material and Method: 21 acute respiratory failure patients under mechanical ventilation support were included in the study. All patients were sedated with propofol infusion to have a sedation level of 3 on the Ramsay scale. After adequate sedation and hemodynamic stability was achieved, baseline values of oxygen consumption, carbondioxide production and energy consumption of the patients were measured by indirect calorimetry device and recorded. Neuromuscular transmission was monitorized by TOF-Guard, and then 0,1 mg/kg bolus dose vecuronium was administered to the patients. When TOF 0, 25, 50, 90 values were obtained, oxygen, carbondioxide and energy consumption were measured by indirect calorimetry device and recorded. Results: No statistically significant difference were found between preand post-curarisation hemodynamic parameters, ventilation parameters, arterial blood gas values (p>0.05). A statistically significant decrease was observed between the oxygen consumption, carbondioxide production and energy consumption measured before curarisation and when TOF value was 0 (p<0.05). However, there was no significant difference between TOF 25, 50, 90 values and the baseline value (p>0.05). Conclusion: It was concluded that the effect of neuromuscular blockage on reducing energy and oxygen consumption should be taken into consideration while calculating the daily energy need in intensive care in patients curarized...

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“…However, Muldoon and Theye [28] reported already in 1969 that whole-body VO 2 was decreased in dogs paralyzed with d-tubocurarine, and some clinical studies investigating the effects of NMB on VO 2 reported a reduction of total-body VO 2 and energy expenditure by NMB in sedated and mechanically ventilated children [8] and in adults suffering acute respiratory failure [7], severe cerebral trauma [29] or burn injuries [30]. Inconsistently, other investigators found no effects of NMB on VO 2 in deeply sedated intensive care unit patients (Ramsay score 5) [31] or in anesthetized patients undergoing cardiac surgery [32].…”

Section: Discussionmentioning

confidence: 99%

“…While NMB has been demonstrated to decrease total body energy expenditure and VO 2 [7,8], to date, a potential influence on anemia tolerance has not been investigated. We hypothesized that NMB should increase the tolerance of acute normovolemic anemia – reflected by a significantly lower value of Hb crit and a higher volume of blood allowed to be exchanged for hydroxyethyl starch (HES).…”

Section: Introductionmentioning

confidence: 99%

Neuromuscular Blockade with Rocuronium Bromide Increases the Tolerance of Acute Normovolemic Anemia in Anesthetized Pigs

et al. 2011

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Background: The patient’s individual anemia tolerance is pivotal when blood transfusions become necessary, but are not feasible for some reason. To date, the effects of neuromuscular blockade (NMB) on anemia tolerance have not been investigated. Methods: 14 anesthetized and mechanically ventilated pigs were randomly assigned to the Roc group (3.78 mg/kg rocuronium bromide followed by continuous infusion of 1 mg/kg/min, n = 7) or to the Sal group (administration of the corresponding volume of normal saline, n = 7). Subsequently, acute normovolemic anemia was induced by simultaneous exchange of whole blood for a 6% hydroxyethyl starch solution (130/0.4) until a sudden decrease of total body O₂ consumption (VO₂) indicated a critical limitation of O₂ transport capacity. The Hb concentration quantified at this time point (Hb_crit) was the primary endpoint of the protocol. Secondary endpoints were parameters of hemodynamics, O₂ transport and tissue oxygenation. Results: Hb_crit was significantly lower in the Roc group (2.4 ± 0.5 vs. 3.2 ± 0.7 g/dl) reflecting increased anemia tolerance. NMB with rocuronium bromide reduced skeletal muscular VO₂ and total body O₂ extraction rate. As the cardiac index increased simultaneously, total body VO₂ only decreased marginally in the Roc group (change of VO₂ relative to baseline –1.7 ± 0.8 vs. 3.2 ± 1.9% in the Sal group, p < 0.05). Conclusion: Deep NMB with rocuronium bromide increases the tolerance of acute normovolemic anemia. The underlying mechanism most likely involves a reduction of skeletal muscular VO₂. During acellular treatment of an acute blood loss, NMB might play an adjuvant role in situations where profound stages of normovolemic anemia have to be tolerated (e.g. bridging an unexpected blood loss until blood products become available for transfusion).

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Effect of neuromuscular blockade on oxygen consumption and energy expenditure in sedated, mechanically ventilated children

Abstract: NMB significantly reduces oxygen consumption and energy expenditure in critically ill children who are sedated and mechanically ventilated; the degree of reduction is small.

Cited by 103 publications

References 15 publications

Factors That Influence the Agreement in Energy Expenditure Assessment in Pediatric Intensive Care Patients

Factors That Influence the Agreement in Energy Expenditure Assessment in Pediatric Intensive Care Patients

Mekanik Ventilasyon Uygulanan Akut Solunum Yetmezlikli Hastalarda Nöromüsküler Blokajın Oksijen ve Enerji Tüketimine Etkisi

Neuromuscular Blockade with Rocuronium Bromide Increases the Tolerance of Acute Normovolemic Anemia in Anesthetized Pigs

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