@book{6650506a664a4451b2ac64018ccb7064,
title = "Facial train-of-four monitoring as an evaluation of neuromuscular blockade in a patient with ICU-acquired weakness",
abstract = "Neuromuscular blocking agents are used in the ICU for various reasons, such as during status asthmaticus and patient-ventilator dyssynchrony. We report a 76-year-old man with adenocarcinoma of the oesophagus treated with laparoscopic transthoracic oesophagectomy, which was complicated by a fistula between the gastric reconstruction and the right main bronchus. He developed extensive ICU-acquired weakness and was treated with differential lung ventilation followed by continuous rocuronium infusion. Evaluation of neuromuscular blockade by train-of-four (TOF) stimulation showed a discrepancy in facial and ulnar TOF monitoring. The different number of neuromuscular junctions at each muscle group could be an explanation for this. Therefore, it is suggested to use facial TOF monitoring in ICU patients instead of ulnar TOF monitoring to differentiate between an intoxication of neuromuscular blockade and ICU-acquired weakness.",
keywords = "NMBAs, ICU-acquired weakness, train-of-four, INTENSIVE-CARE-UNIT, ORBICULARIS OCULI",
author = "J. Epskamp and {van Duijvendijk}, P. and A. Kroner and Spronk, {P. E.}",
year = "2021",
month = may,
language = "English",
volume = "29",
series = "Netherlands Journal of Critical Care",
publisher = "NETHERLANDS SOC INTENSIVE CARE",
edition = "3",
}