NEUROMUSCULAR BLOCKADE DOES NOT DECREASE OXYGEN-CONSUMPTION OR ENERGY-EXPENDITURE BEYOND SEDATION IN THE MECHANICALLY VENTILATED CHILD

Minimizing the high oxygen consumption and energy expenditure of the c ritically ill is an important therapeutic goal. This study was done to determine if neuromuscular blockade decreases oxygen consumption or e nergy expenditure more than sedation alone in the mechanically ventila ted child. Twelve burned children, with an average age of 5.1 +/- 1.6 yrs, average weight of 22.8 +/- 6.5 kg, and average burn size of 28.3 +/- 5.8% of the body surface, scheduled for a planned surgical procedu re under general anesthesia were enrolled in this prospective self-con trolled study In conjunction with planned operative procedures and usi ng an intravenous anesthetic technique, the children underwent expired gas collection before and after neuromuscular block ade was induced. Expired gas was collected and analyzed for the fractional concentratio n of oxygen and carbon dioxide. oxygen consumption (VO2), carbon dioxi de production (VCO2), energy expenditure (EE), and respiratory quotien t (RQ) were calculated. We found no significant difference in EE, VO2, VCO2, or RQ between the well-sedated and mechanically ventilated and the well-sedated, mechanically ventilated and paralyzed states. We the refore concluded that neuromuscular blockade does not decrease energy expenditure in the otherwise well-sedated burned child.