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 critically ill is an important therapeutic goal. This study was done to determine if neuromuscular blockade decreases oxygen consumption or energy expenditure more than sedation alone in the mechanically ventilated 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 procedure under general anesthesia were enrolled in this prospective self-controlled study. In conjunction with planned operative procedures and using an intravenous anesthetic technique, the children underwent expired gas collection before and after neuromuscular blockade was induced. Expired gas was collected and analyzed for the fractional concentration of oxygen and carbon dioxide. Oxygen consumption (VO₂), carbon dioxide production (VCO₂), energy expenditure (EE), and respiratory quotient (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 therefore concluded that neuromuscular blockade does not decrease energy expenditure in the otherwise well-sedated burned child.