Train‐of‐Four: To Use or Not to Use

Tschida, Suzanne J.; Hoey, Lori L.; Mather, Dell; Vance‐Bryan, Kyle

doi:10.1002/j.1875-9114.1995.tb04396.x

Pharmacotherapy

1995

DOI: 10.1002/j.1875-9114.1995.tb04396.x

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Train‐of‐Four: To Use or Not to Use

Suzanne J. Tschida,

Lori L. Hoey,

Dell Mather

et al.

Abstract: A pattern of nerve stimulation called train‐of‐four (TOF) is frequently used to monitor therapy with nondepolarizing neuromuscular blocking agents in patients treated in intensive care units. Based on our experience with TOF monitoring in several critically ill patients, we believe its application as an indicator of neuromuscular blockade may be problematic in this setting.

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Cited by 7 publications

References 27 publications

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Pharmacotherapy for Acute Respiratory Distress Syndrome

Shafeeq

Lat

2012

Pharmacotherapy

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Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) represent a continuum of a clinical syndrome of respiratory failure due to refractory hypoxia. Acute respiratory distress syndrome is differentiated from ALI by a greater degree of hypoxemia and is associated with higher morbidity and mortality. The mortality for ARDS ranges from 22-41%, with survivors usually requiring long-term rehabilitation to regain normal physiologic function. Numerous pharmacologic therapies have been studied for prevention and treatment of ARDS; however, studies demonstrating clear clinical benefit for ARDS-related mortality and morbidity are limited. In this focused review, controversial pharmacologic therapies that have demonstrated, at minimum, a modest clinical benefit are discussed. Three pharmacologic treatment strategies are reviewed in detail: corticosteroids, fluid management, and neuromuscular blocking agents. Use of corticosteroids to attenuate inflammation remains controversial. Available evidence does not support early administration of corticosteroids. Additionally, administration after 14 days of disease onset is strongly discouraged. A liberal fluid strategy during the early phase of comorbid septic shock, balanced with a conservative fluid strategy in patients with ALI or ARDS during the postresuscitation phase, is the optimum approach for fluid management. Available evidence supports an early, short course of continuous-infusion cisatracurium in patients presenting with severe ARDS. Evidence of safe and effective pharmacologic therapies for ARDS is limited, and clinicians must be knowledgeable about the areas of controversies to determine application to patient care.

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Pharmacotherapy for Acute Respiratory Distress Syndrome

Shafeeq

Lat

2012

Pharmacotherapy

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Pharmacotherapy for Acute Respiratory Distress Syndrome

Fan

2012

Pharmacotherapy

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Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient

Murray

Cowen

DeBlock

et al. 2002

Critical Care Medicine

269

193

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Train‐of‐Four: To Use or Not to Use

Cited by 7 publications

References 27 publications

Pharmacotherapy for Acute Respiratory Distress Syndrome

Pharmacotherapy for Acute Respiratory Distress Syndrome

Pharmacotherapy for Acute Respiratory Distress Syndrome

Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient

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