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Application of monitoring tools seemed inappropriate in ICU patients who were ventilated during a prolonged period.
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| Name | Class |
|---|---|
| Mayo Clinic | OTHER |
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In intensive care unit (ICU) patients who are mechanically ventilated for a longer period of time, there might be a difference in accuracy and performance of neuromuscular transmission monitoring [as measured by the train-of-four (TOF)%] due to a pre-existing TOF fade, correlated to some form of acquired muscle weakness. The investigators therefore propose to search for and compare the optimal monitoring techniques (acceleromyography vs. electromyography) and the optimal muscle monitoring site (peripheral-adductor pollicis vs. central-corrugator supercilii) in ICU patients who require prolonged mechanical ventilation.
The following neuromuscular transmission monitors will be used in the study: an electromyography-based monitor (TetraGraph, Senzime AB, Uppsala, Sweden) and two devices that are the newer generation of quantitative monitoring using three-dimensional acceleromyographic technology: Stimpod (Xavant Technology, Pretoria, South Africa) and TofScan (IDmed, Marseilles, France), both of which require minimal setup for use.
The stimulation pattern of both ulnar and facial nerves will be train-of-four (TOF) delivered every 1 minute, and the mean of three consecutive measurements will be calculated as the TOF% for that patient. Patients will be tested every 24 hrs, once a day, at the same time, over the 72 hrs the study will take place in the ICU.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| electromyographic NMT monitoring at the hand | Experimental | In 20 mechanically ventilated ICU patients, TOF measurements will be performed every 24 hrs, once a day, at the same time, over the 72 hrs the study will take place in the ICU. |
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| acceleromyographic NMT monitoring at the hand | Experimental | In 20 mechanically ventilated ICU patients, TOF measurements will be performed every 24 hrs, once a day, at the same time, over the 72 hrs the study will take place in the ICU. |
|
| acceleromyographic NMT monitoring at the eyebrow | Experimental | In 20 mechanically ventilated ICU patients, TOF measurements will be performed every 24 hrs, once a day, at the same time, over the 72 hrs the study will take place in the ICU. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TOF measurements | Diagnostic Test | The investigators will determine how the TOF% values vary in each individual patient, over time, in ICU. |
|
| Measure | Description | Time Frame |
|---|---|---|
| pre-existing neuromuscular fade (TOF% <90), correlated to some form of ICU acquired muscle weakness, in ICU patients mechanically ventilated for more than 72 hrs. | to find whether any patients show any pre-existing neuromuscular fade or develop such weakness over the 72 hours of study period in ICU | 72 hours of study period in ICU |
| Measure | Description | Time Frame |
|---|---|---|
| fade (TOF% <90) difference between central (corrugator supercilii) and peripheral (adductor pollicis) muscles in ICU patients who require prolonged mechanical ventilation. | to compare the development of fade (if any develops) between central and peripheral muscles over the 72 hours of study period in ICU | 72 hours of study period in ICU |
| Measure | Description | Time Frame |
|---|---|---|
| optimal monitor for use in the ICU setting | to determine the TOF% repeatability of the three monitors, establishing the optimal monitor for use in the ICU setting | 72 hours of study period in ICU |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Guy Cammu, MD,PhD | Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| OLV Hospital | Aalst | 9300 | Belgium |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28044330 | Background | Naguib M, Brull SJ, Johnson KB. Conceptual and technical insights into the basis of neuromuscular monitoring. Anaesthesia. 2017 Jan;72 Suppl 1:16-37. doi: 10.1111/anae.13738. | |
| 30447682 | Background | Cammu G, Neyens E, Coddens J, Van Praet F, De Decker K. Postoperative residual curarisation is still an issue when weaning patients in intensive care following cardiac surgery. Anaesth Intensive Care. 2018 Nov;46(6):634-636. No abstract available. |
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Twenty mechanically ventilated ICU patients: the investigators will compare the mean TOF% between three different measurement techniques in 20 mechanically ventilated ICU patients: 1/electromyographic neuromuscular transmission monitoring at the hand muscle - 2/acceleromyographic neuromuscular transmission monitoring at the hand muscle - 3/acceleromyographic neuromuscular transmission monitoring at the eyebrow muscle; and the investigators will determine how the three TOF% values vary in each individual patient.
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