Is less really more? A critical appraisal of a POPULAR study reanalysis

Fuchs‐Buder, Thomas; Brull, Sorin J.

doi:10.1016/j.bja.2019.09.038

Cited by 4 publications

(2 citation statements)

References 17 publications

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“…30 This is in line with the report from Fuchs-Buder et al related to the POPULAR study that having recommendations in place is not enough, but rather that evidencebased guidelines for NMM and reversal must actually be followed to improve patient safety and reduce harm. 2 These observations clearly highlight the potential risks for a continued failure by some providers to use the available technology and change long-held and dangerous beliefs that such monitoring is unnecessary. This is in line with our findings showing that even after significant improvement in care delivered that was in line with the ASPIRE NMB-01 guideline, we still only reached approximately 70% compliance.…”

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confidence: 99%

“…Train of four (TOF) monitoring plays an important role in assessing the depth of neuromuscular blockade (NMB), in guiding appropriate dosing of neuromuscular blocking agents and their antagonists, and in assessing the adequacy of NMB reversal prior to extubation. 1,2 Appropriate use of TOF monitoring helps prevent the occurrence of residual neuromuscular blockade (RNMB) which can lead to significant respiratory complications, including hypoxemia, airway obstruction, and need for reintubation, as well as increased risk for increased postanesthesia care unit length of stay and critical care admission. [3][4][5] Neuromuscular monitoring (NMM) by TOF ratio, a quantitative measure of NMB, along with appropriate dosing of neuromuscular reversal, has been shown to reduce the incidence of RNMB and its associated complications when compared to clinical tests and qualitative measures.…”

Section: Introductionmentioning

confidence: 99%

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Improving Compliance With Institutional Performance on Train of Four Monitoring

Santapuram

Fowler

Garvey

et al. 2023

JEPM

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Background: We performed a multistep quality improvement project related to neuromuscular blockade and monitoring to evaluate the effectiveness of a comprehensive quality improvement program based upon the Multi-institutional Perioperative Outcomes Group (MPOG) Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) metrics targeted specifically at improving train of four (TOF) monitoring rates. Methods:We adapted the plan-do-study-act (PDSA) framework and implemented 2 PDSA cycles between January 2021 and December 2021. PDSA Cycle 1 (Phase I) and PDSA Cycle 2 (Phase II) included a multipart program consisting of (1) a departmental survey assessing attitudes toward intended results, outcomes, and barriers for TOF monitoring, (2) personalized MPOG ASPIRE quality performance reports displaying provider performance, (3) a dashboard access to help providers complete a case-by-case review, and (4) a web-based app spaced education module concerning TOF monitoring and residual neuromuscular blockade. Our primary outcome was to identify the facilitators and barriers to implementation of our intervention aimed at increasing TOF monitoring.

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confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving Compliance With Institutional Performance on Train of Four Monitoring

Santapuram

Fowler

Garvey

et al. 2023

JEPM

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Exploratory analysis of POPULAR data: learning to improve. Comment on Br J Anaesth 2020; 124: 63–72

Carron¹,

Linassi²,

Cassai³

et al. 2020

British Journal of Anaesthesia

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Forty years of neuromuscular monitoring and postoperative residual curarisation: a meta-analysis and evaluation of confidence in network meta-analysis

Carvalho

Verdonck

Cools

et al. 2020

British Journal of Anaesthesia

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Background: The reported incidence of postoperative residual curarisation (PORC) is still unacceptably high. The capacity of intraoperative neuromuscular monitoring (NMM) to reduce the incidence of PORC has yet to be established from pooled clinical studies. We conducted a meta-analysis of data from 1979 to 2019 to reanalyse this relationship. Methods: English language, peer-reviewed, and operation room adult anaesthesia setting articles published between 1979 and 2019 were searched for on PubMed, Cochrane Central Register of Controlled Trials, ISI-WoK, and Scopus. The primary outcome was PORC incidence as defined by an at-or post-extubation train-of-four ratio (TOFR) of lower than 0.7, 0.9, or 1.0. Additional collected variables included the duration of action of neuromuscular blocking agents (NMBAs) used, sugammadex or neostigmine use, and the technique of anaesthesia maintenance. Results: Fifty-three studies (109 study arms, 12 664 patients) were included. The pooled PORC incidence associated with the use of intermediate duration NMBAs and quantitative NMM was 0.115 (95% confidence interval [CI], 0.057e0.188). This was significantly lower than the PORC rate for both qualitative NMM (0.306; 95% CI, 0.09e0.411) and no NMM (0.331; 95% CI, 0.234e0.435). Anaesthesia type did not significantly affect PORC incidence. Sugammadex use was associated with lower PORC rates. The GRADE global level of evidence was very low and the refined assessment of the network metaanalysis by means of a confidence in network meta-analysis raised concerns on within-and across-study bias. Conclusions: Quantitative NMM outperforms both subjective and no NMM monitoring in reducing PORC as defined by a TOFR of <0.9.

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Is less really more? A critical appraisal of a POPULAR study reanalysis

Cited by 4 publications

References 17 publications

Improving Compliance With Institutional Performance on Train of Four Monitoring

Improving Compliance With Institutional Performance on Train of Four Monitoring

Exploratory analysis of POPULAR data: learning to improve. Comment on Br J Anaesth 2020; 124: 63–72

Forty years of neuromuscular monitoring and postoperative residual curarisation: a meta-analysis and evaluation of confidence in network meta-analysis

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