Sunday November 27, 2005
Can we go without Train of Four (TOF) ?
On literature search we found atleast 2 decent (though small) studies questioning the need of Train of Four (TOF) which is considered so far to be the standard of care while patient on continuous- infusion neuromuscular blocking agents (NMB).
1. Div. of Pulm. & CCM, Med. Univ. of South Carolina, Charleston - compared 20 patients with TOF and 16 patients with best clinical assessment group and found no difference. (NMB used was Atracurium).
2. Div. of Pulm. & CCM, Univ. of Mississippi Med. Center, Jackson - compared 16 patients with TOF and 14 patients with best clinical assessment group and found no difference. (NMB used was cisatracurium).
But strong arguments made in favour of TOF by Dr. Sessler is also worth reading. (Click Ref. 3)
See nice article covering most aspect on TOF here from Dimensions of Critical Care Nursing.
References: click to get abstract/article
1. Comparison of Train-of-Four and Best Clinical Assessment during Continuous Paralysis - Am. J. Respir. Crit. Care Med., Volume 156, Number 5, November 1997, 1556-1561
2. A Prospective Randomized Comparison of Train-of-Four Monitoring and Clinical Assessment During Continuous ICU Cisatracurium Paralysis - Chest. 2004;126:1267-1273
3. Train-of-Four To Monitor Neuromuscular Blockade? - Curtis N. Sessler, MD, FCCP - Chest. 2004;126:1018-1022.
4. An Algorithm for Train-of-Four Monitoring in Patients Receiving Continuous Neuromuscular Blocking Agents - Dimensions of Critical Care Nursing, March/April 2003 Volume 22 Number 2 Pages 50 - 57