The Use of Neuromuscular Blocking Agents in the ICU: Where Are We Now?

@article{Greenberg2013TheUO,
  title={The Use of Neuromuscular Blocking Agents in the ICU: Where Are We Now?},
  author={Steven B. Greenberg and Jeffery Vender},
  journal={Critical Care Medicine},
  year={2013},
  volume={41},
  pages={1332–1344}
}
Intensivists use neuromuscular blocking agents for a variety of clinical conditions, including for emergency intubation, acute respiratory distress syndrome, status asthmaticus, elevated intracranial pressure, elevated intra-abdominal pressure, and therapeutic hypothermia after ventricular fibrillation–associated cardiac arrest. The continued creation and use of evidence-based guidelines and protocols could ensure that neuromuscular blocking agents are used and monitored appropriately. A… 
View on Wolters Kluwer
criticalcarelearningpod.weebly.com
52 Citations
Highly Influential Citations
8
Background Citations
17
Methods Citations
3

52 Citations

Citation Type

Citation Type

Review of Continuous Infusion Neuromuscular Blocking Agents in the Adult Intensive Care Unit
TLDR
Clinicians are provided with information regarding pharmacologic differences, indication for use, adverse effects, recommended doses, ancillary care, and monitoring among agents used for continuous neuromuscular blockade.
Neuromuscular Blocking Agents
TLDR
Curarization has to be discontinued as soon as possible, according to the clinical needs, trying to avoid short- and long-term complications.
Neuromuscular Blockade in the 21st Century Management of the Critically Ill Patient
Neuromuscular-blocking agent use in critically ill patients
TLDR
There is evidence supporting short course (<48 h) of paralysis for patients with moderate-to-severe acute respiratory distress syndrome with PaO2/FiO2 ratio <150.
Role of Pharmacologic Paralysis in Acute Respiratory Distress Syndrome
TLDR
Current use of neuromuscular blockade is highly variable, likely due to limited evidence for efficacy beyond short‐term physiologic improvement and lingering concerns for harm.
Sedation, Analgesia Delirium in the ECMO Patient
The goal of this chapter is to identify medications frequently utilized for sedation and analgesia in Extracorporeal Membrane Oxygenation (ECMO) patients. In addition to describing basic…
Chapter 14 Sedation , Analgesia Delirium in the ECMO Patient
The goal of this chapter is to identify medications frequently utilized for sedation and analgesia in Extracorporeal Membrane Oxygenation (ECMO) patients. In addition to describing basic…
Sugammadex for Neuromuscular Blockade Reversal
TLDR
Sugammadex, a modified &ggr;-cyclodextrine compound, is a recently approved agent for the reversal of blockade with aminosterodial neuromuscular blockers, indicating faster and more consistent reversal of blockers while leading to fewer adverse events.
Neuromuscular blocking agents for acute respiratory distress syndrome.
Editor’s Choice-The cardiovascular implications of sedatives in the cardiac intensive care unit
TLDR
The use of common sedatives available in the endotracheally intubated critically ill patient and their clinical and cardiovascular effects are described and judicious strategies minimizing sedative use are associated with decreases in morbidity and mortality.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 171 REFERENCES
Airway management in the critically ill patient.
Neuromuscular-blocking drugs. Use and misuse in the intensive care unit.
When Should Sedation or Neuromuscular Blockade Be Used During Mechanical Ventilation?
TLDR
The goal of sedation is a calm, comfortable patient who can easily be aroused and who can tolerate mechanical ventilation and procedures required for their care.
Airway management of the critically ill patient: rapid-sequence intubation.
TLDR
The purpose of this article is to review airway management in the critically ill adult with an emphasis on airway assessment, algorithmic approaches, and RSI.
Neuromuscular blockade and skeletal muscle weakness in critically ill patients: time to rethink the evidence?
TLDR
Evidence is provided that neuromuscular blocking agents may not be a major cause of weakness in a 21st century critical care setting and the established clinical view of an adverse relationship between the use of these agents and skeletal muscle weakness is challenged.
Use of sedatives, opioids, and neuromuscular blocking agents in patients with acute lung injury and acute respiratory distress syndrome*
TLDR
The use of sedatives, opioids, and neuromuscular blocking agents (NMBAs) may delay weaning and prolong intensive care unit length of stay and was associated with a longer time to achieve important weaning landmarks.
Neuromuscular blockers in early acute respiratory distress syndrome.
TLDR
In patients with severe ARDS, early administration of a neuromuscular blocking agent improved the adjusted 90-day survival and increased the time off the ventilator without increasing muscle weakness.
Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related complications*
TLDR
The use of neuromuscular blocking agents, when used by intensivists with a high level of training and experience, is associated with a decrease in procedure-related complications.
Analytic Reviews: Managing the Agitated Patient in the ICU: Sedation, Analgesia, and Neuromuscular Blockade
TLDR
Structured protocols and objective assessment tools can optimize drug delivery and may ultimately improve patient outcomes by reducing ventilator days, ICU length of stay, and by reducing cognitive dysfunction.
Current Therapeutic Uses, Pharmacology, and Clinical Considerations of Neuromuscular Blocking Agents for Critically III Adults
TLDR
NMBAS are high-alert medications used to manage critically ill patients and emerging data support the use of cisatracurium in select patients with ALI/ARDS, but current literature does not support theUse of one NMBA over another for other critical care indications.
...
1
2
3
4
5
...