Abstract
To evaluate the subjective impression of improved gas exchange with muscle paralysis in some infants on mechanical ventilation, we observed 35 infants who received pancuronium while on Baby Bird ventilators. Pancuronium (0.1 mg/kg I.V.) was repeated until spontaneous respirations ceased in infants who had inadequate gas exchange with FIO2 > 0.60, peak inspiratory pressure >30cm H2O or who were “fighting” the ventilator. 27 infants received pancuronium within the first 48 hours of life, 15 within the first 24 hours. Infants remained paralyzed for a median of 36 hours. 27 infants had ≥ torr before paralysis. ≥ improved by >100 torr within one hour of paralysis in only 2 of the 27 infants; it worsened in 2 infants within the same period. By 6 hours post-paralysis, 12 infants had improved, 5 of whom had had a worsening ≥ before administration of pancuronium. ≥ decreased in 5 infants by > 10 torr within 1 hour of paralysis and increased in 8 infants with either unchanged ventilator settings or changes expected to improve ventilation. No significant changes were observed in blood pressure or heart rate. Only 4 of the 35 infants developed a pneumothorax while paralyzed. Since birthweight, gestational age, or diagnosis could not distinguish those who would respond, one can determine efficacy in a particular patient only by trial. Improvement, when it occurs, is most likely related to changes in right-to-left shunting or V/Q abnormality.
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Stark, A., Bascom, R. & Frantz, I. 1234 RESPONSES TO MUSCLE PARALYSIS IN MECHANICALLY VENTI LATED INFANTS. Pediatr Res 12 (Suppl 4), 569 (1978). https://doi.org/10.1203/00006450-197804001-01240
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DOI: https://doi.org/10.1203/00006450-197804001-01240