Train-of-four (TOF) monitoring is recommended in published guidelines during use of continuous-infusion neuromuscular blocking agents (NMB) in the intensive care unit (ICU). To test that recommendation, dual protocols were established in a medical ICU after intensive nursing education. Paralyzed patients received either TOF monitoring with a goal of three twitches or best clinical assessment while receiving atracurium by continuous infusion. Demographics and mean duration of paralysis of 20 patients in the TOF group were no different than that of the 16 patients in the best clinical assessment group. Although most patients demonstrated atracurium tolerance over time, there was no difference between groups in total mg (+/- SEM) infused (10,460 +/- 2,409 versus 9,201 +/- 3,237) or mean microgram/kg/min (15.2 +/- 1.5 versus 12.0 +/- 1.1). The time to clinical recovery was no different between groups (50 +/- 10 versus 45 +/- 12 min). Two complications occurred in the TOF group, with pulmonary emboli despite prophylaxis and an unrecognized cerebrovascular accident in one patient each. We conclude that careful titration of NMB using clinical bedside markers should remain the standard of care with these drugs.

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This article describes a collaborative professional development model in which faculty in a College of Education partnered with a local school district to design and implement a year-long project in an effort to increase effective integration of technology in instruction by K-8 classroom teachers, university teacher preparation faculty, pre-service teachers and novice teachers graduating from that teacher preparation program. A brief description of the project, its accomplishments and dilemmas, analysis of the project design and experiences of participants through the lens of situative professional development are presented. Lessons for structuring professional development such that subsequent improvements in technology use within partnership schools and teacher preparation programs can occur are discussed.

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