Honsel Maik, Giugni Cristina, Brierley Joe
Paediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Acta Paediatr. 2014 Sep;103(9):e370-3. doi: 10.1111/apa.12682. Epub 2014 Jun 20.
Neuromuscular blocking agents (NMBAs) are used in a range of critical illnesses in neonates and infants, despite a lack of guidelines and professional standards. This study reviewed the current evidence base and ascertained UK practice regarding the continuous use of these agents in this age range.
We reviewed the literature and carried out a telephone questionnaire of all tertiary units in England and specialist children's hospital neonatal units in the UK.
No best practice guidelines or general consensus statements were found, and the only randomised trial to feature an NMBA protocol expressed concerns about its use in such young babies. Of the 56 units contacted, 54 (96.4%) shared information. Only three of the 56 (5.4%) used intermittent boluses of NMBAs, 91.1% used NMBA infusions, 11 (19.6%) routinely used regular neuromuscular blocker pause to assess depth, and only one (1.8%) used peripheral nerve stimulation monitoring. All the units carried out clinical assessments, but only one (1.8%) had a written protocol.
There is a paucity of literature and professional standards to guide the safe use of NMBAs in infants. Of the 54 units who participated in the survey, only one had a protocol for using NMBAs in babies.
尽管缺乏指南和专业标准，但神经肌肉阻滞剂（NMBAs）仍被用于一系列新生儿和婴儿的危重症中。本研究回顾了当前的证据基础，并确定了英国在此年龄范围内持续使用这些药物的实际情况。
我们回顾了文献，并对英国所有英格兰的三级医疗机构和专科医院的新生儿病房进行了电话问卷调查。
未发现最佳实践指南或普遍共识声明，唯一一项以NMBA方案为特色的随机试验对其在如此年幼婴儿中的使用表示担忧。在联系的56个单位中，54个（96.4%）分享了信息。56个单位中只有3个（5.4%）使用NMBAs间歇性推注，91.1%使用NMBA输注，11个（19.6%）常规使用定期的神经肌肉阻滞剂暂停以评估深度，只有1个（1.8%）使用外周神经刺激监测。所有单位都进行了临床评估，但只有1个（1.8%）有书面方案。
缺乏指导婴儿安全使用NMBAs的文献和专业标准。在参与调查的54个单位中，只有1个单位有婴儿使用NMBAs的方案。
