Evidence map›Paper›PMID 37176693›Full record

ArticleJournal of clinical medicine2023

Reversing Neuromuscular Blockade without Nerve Stimulator Guidance in a Postsurgical ICU-An Observational Study.

Andrea Calef, Rashel Castelgrande, Kristin Crawley, Sara Dorris, Joanna Durham, Kaitlin Lee, Jen Paras, Kristen Piazza, Abigail Race, Laura Rider and 5 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of clinical medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Fast-Track Extubation After Cardiac Surgery: A Narrative Review.Journal of cardiovascular development and disease · 2025
    Review
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Andrea CalefDepartment of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Rashel CastelgrandeDepartment of Surgery, Anne Arundel Medical Center, Anne Arundel, MD 21401, USA.
Kristin CrawleyDepartment of Surgery, Medstar Medical Group, Baltimore, MD 21201, USA.
Sara DorrisDepartment of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Joanna DurhamDepartment of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Kaitlin LeeDepartment of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Jen ParasDepartment of Surgery, INOVA Fairfax Hospital, Fairfax, VA 22042, USA.
Kristen PiazzaDepartment of Surgery, University of Maryland St Joseph Hospital, Baltimore, MD 21201, USA.
Abigail RaceDepartment of Surgery, North Shore University Hospital, Manhasset, NY 11030, USA.
Laura RiderDepartment of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Michael ShelleyDepartment of Surgery, Maine Medical Center, Portland, ME 04103, USA.
Emily StewartDepartment of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Miranda TamokDepartment of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Jennifer TateDepartment of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Jeffrey M Dodd-ODepartment of Anesthesiology, Johns Hopkins Hospital, Baltimore, MD 21287, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

We aimed to determine if not using residual neuromuscular blockade (RNB) analysis to guide neuromuscular blockade reversal administration in the postsurgical ICU resulted in consequences related to residual weakness. This single-center, prospective study evaluated 104 patients arriving in a postcardiac surgical ICU. After demonstrating spontaneous movement and T > 35.5 °C, all patients underwent RNB evaluation, and neostigmine/glycopyrrolate was then administered. When patients later demonstrated an adequate Rapid Shallow Breathing Index, negative inspiratory force generation, and arterial blood gas values with minimal mechanical ventilatory support, RNB evaluation was repeated in 94 of the 104 patients, and all patients were extubated. Though RNB evaluation was performed, patients were extubated without considering these results. Eleven of one hundred four patients had not achieved a Train-of-Four (TOF) count of four prior to receiving neostigmine. Twenty of ninety-four patients demonstrated a TOF ratio ≤ 90% prior to extubation. Three patients received unplanned postextubation adjunct respiratory support-one for obvious respiratory weakness, one for pain-related splinting compounding baseline disordered breathing but without obvious benefit from BiPAP, and one for a new issue requiring surgery. Residual neuromuscular weakness may have been unrecognized before extubation in 1 of 104 patients administered neostigmine without RNB analysis. ICU-level care may mitigate consequences in such cases.

Indexed as

neostigmineNeuromuscular blockade reversalsresidual neuromuscular blockade

Identifiers

PMID37176693
PMCPMC10179105

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.