Background and Aims Neuromuscular blocking agents (NMBAs), either intermittent boluses or continuous infusions, are used in infants to facilitate difficult ventilation and lower pulmonary pressures by preventing infant-ventilator asynchrony in e.g. severe meconium aspiration syndrome, persistent pulmonary hypertension or air leak.
Whilst consensus statements and accepted standards regarding NMBA use and assessment exist in adult and paediatric ICU, there exists limited information in NICU, specifically whether clinical assessment, NMBA-monitoring (train-of-4) or formal acceleromyography is optimal. We wanted to ascertain current NMBA monitoring in UK NICU.
Methods Literature search for NMBA assessment in infants and telephone survey of all tertiary NICUs in England, and major units in Wales, Scotland and Northern Ireland, in which we asked the nurse in charge (to ascertain actual rather than perceived optimal practice) about existing protocols, methods used for NMBA monitoring (clinical observation, TOF/acceleromyography) and the use of ‘drug holidays’.
Results No standards, or peer-reviewed NMBA guidelines were found. Of 56 units contacted, 2 did not share information and 3 use intermittent boluses of NMBAs rather than continuous infusion. Of the remaining units all (100%) clinically assess the patient, 1 (1.96%) has a protocol in place, 11 (21.57%) perform regular NMBA-holidays to assess effect and 1 (1.96%) uses train-of-4 if a patient on NMBA-holiday does not move after 6 hours.
Conclusions We found no peer reviewed NICU-NMBA standards or guidelines in the literature, Only 1 UK unit has any protocol for NMBA assessment. Guidelines/standards for NMBA use in infants need to be urgently introduced.