Monitoring of Neuromuscular Blockade in the Intensive Care Unit: a Reliability Study (CURAREA)

July 28, 2026 updated by: Romain Ronfle, Centre Hospitalier Intercommunal Aix-Pertuis

The objective of this clinical trial is to evaluate the reliability of neuromuscular blockade monitoring in adult intensive care patients depending on the clinical context.

The main questions it aims to answer are as follows:

  • Detection of an anomaly at ulnar "TOF" stimulation in patients without neuromuscular blockade
  • Absence of adverse events during clinical monitoring of neuromuscular blockade (every 24 hours): absence of respiratory effort movements or patient-ventilator asynchrony (safety)

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Muscle relaxation in the intensive care unit is a commonly used therapeutic approach, but one that remains controversial due to a debated benefit-risk ratio depending on the clinical context. First, neuromuscular blockade is a common technique in the operating room to facilitate orotracheal intubation or to improve surgical comfort during the procedure.

The French Society of Anesthesia and Intensive Care (SFAR) recommends intraoperative monitoring of neuromuscular blockade and recovery from neuromuscular blockade for patients under general anesthesia who have received neuromuscular blocking agents. It is recommended to use ulnar nerve stimulation at the wrist with visual or tactile assessment of thumb adductor contraction, given the ease of access as well as the potential to quantify the muscular response of this muscle. When deep neuromuscular blockade of the body's most resistant muscles (diaphragm, abdominal wall muscles) is indicated, it is recommended to wait until the four responses to the four-pulse train to the thumb adductor have disappeared and to monitor using Post-Tetanic Count (PTC) stimulation. In this case, the presence of one to five responses to the thumb adductor indicates complete paralysis of the abdominal muscles. Stimulation of the facial nerve in four-pulse trains and visual assessment of the response in the corrugator supercilii muscle is an alternative to the ulnar nerve test. The neuromuscular blockade profile of the corrugator supercilii muscle is comparable to that of the body's most resistant muscles, such as the laryngeal adductors or the diaphragm.

In the intensive care unit, neuromuscular blockade is primarily used for emergency orotracheal intubation and in cases of severe acute respiratory distress syndrome (ARDS). In moderate-to-severe cases, some patients require deep, continuous sedation during the initial phase, sometimes in combination with neuromuscular blockade. Early and continuous infusion of cisatracurium during the initial phase of severe ARDS (P/F < 150) has demonstrated a clear clinical benefit in terms of 90-day mortality through several pathophysiological mechanisms. However, prolonged use of neuromuscular blockade is also associated with neuromuscular weakness and requires deep sedation, which can itself have negative consequences. Despite the lack of robust evidence, monitoring of neuromuscular blockade is recommended in patients in the intensive care unit. Monitoring the depth of neuromuscular blockade would help ensure that neuromuscular blockade goals are met while using the lowest possible doses of neuromuscular blocking agents.

Clinical assessment based on observation of respiratory effort or detection of patient-ventilator asynchrony should be combined with a quantitative method for evaluating neuromuscular blockade: "Train-of-four" (TOF) or "post-tetanic count" (PTC) . However, no study has examined the feasibility of this technique in our intensive care patients across different clinical contexts. The data have been extrapolated from the operating room, even though the use of neuromuscular blockers in the ICU differs and certain clinical situations may make interpretation of the monitoring results potentially difficult: ICU-acquired neuromyopathy, therapeutic hypothermia, and interstitial edema.

These clinical situations may alter the muscle response to electrical stimulation and thus skew the results of "TOF" or "PTC" monitoring.

The objective of our study is to evaluate the reliability of neuromuscular blockade monitoring in intensive care patients.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
160

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • France
      • Aix-en-Provence, France, 13090
        • Recruiting
        • Centre Hospitalier Intercommunal Aix-Pertuis
        • Contact:
        • Principal Investigator:
          • Romain Ronflé, Dr

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adult patients
  • Patients admitted to the intensive care unit who have been receiving neuromuscular blocking agents for at least 24 hours during their stay - Consent obtained from the patient or emergency consent obtained from family members
  • Patients covered by the French social security system, regardless of the specific plan

Exclusion Criteria:

  • Patients who have already been exposed to prolonged neuromuscular blockade or who have been receiving continuous neuromuscular blockade for less than 24 hours
  • Allergy to neuromuscular blocking agents
  • Patients with a neurological condition that alters the interpretation of neuromuscular blockade or contraindicates the use of neuromuscular blocking agents
  • Patients enrolled in an interventional study
  • Patients who object to the collection of their medical data for this study
  • Patients under the age of 18
  • Patients deprived of their liberty, under guardianship, or under conservatorship
  • Pregnant or breastfeeding women

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: monitoring of muscle relaxation
Device: neuromuscular blockade monitoring
The goal of monitoring neuromuscular blockade in an intensive care patient is to ensure the effectiveness of the technique through adequate neuromuscular blockade. In addition to a clinical assessment based on observation of respiratory effort or detection of patient-ventilator asynchrony, this monitoring includes the use of quantitative methods with TOFscan Idmed device to evaluate neuromuscular blockade: "TOF" and "PTC." The use of neuromuscular blocking agents and their monitoring are governed by a standard care protocol in each participating center. The investigators will study, within the context of routine care, the reliability and reproducibility of this technique, which was initially applied and validated in patients in the operating room and subsequently adapted for use in intensive care patients.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Proportion of abnormal "train of four" (TOF) responses (TOF ≠ 4 responses) among all evaluations performed on each patient.
Time Frame: From admission to discontinuation of sedation, for up to 15 days
TOF stimulation is one of the most commonly used types of stimulation; it consists of four stimuli (each lasting 200 μs) spaced 0.5 seconds apart. Without neuromuscular blockade, the expected answer in intensive care patients are 4 out of 4
From admission to discontinuation of sedation, for up to 15 days

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Comparison of the response to ulnar "TOF" and "PTC" stimulation versus orbicularis "TOF" stimulation in patients under neuromuscular blockade (effectiveness)
Time Frame: From admission to discontinuation of sedation, for up to 15 days
The aim is to highlight a correlation between ulnar and orbicularis stimulation
From admission to discontinuation of sedation, for up to 15 days
Absence of adverse events during clinical monitoring of neuromuscular blockade:
Time Frame: From admission to discontinuation of sedation, for up to 15 days
absence of respiratory effort movements or patient-ventilator asynchrony (safety record)
From admission to discontinuation of sedation, for up to 15 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Centre Hospitalier Intercommunal Aix-Pertuis

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
April 2, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
January 1, 2027

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
January 1, 2027

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
July 15, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 28, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
August 3, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
August 3, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 28, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
July 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 2025-A02564-45

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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