A fresh look at paralytics in the critically ill

Real promise and real concern

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Neuromuscular blocking agents (NMBAs), or "paralytics," often are deployed in the sickest patients in the intensive care unit (ICU) when usual care fails. Despite the publication of guidelines on the use of NMBAs in the ICU in 2002, clinicians have needed more direction to determine which patients would benefit from NMBAs and which patients would be harmed. Recently, new evidence has shown that paralytics hold more promise when used in carefully selected lung injury patients for brief periods of time. When used in early acute respiratory distress syndrome (ARDS), NMBAs assist to establish a lung protective strategy, which leads to improved oxygenation, decreased pulmonary and systemic inflammation, and potentially improved mortality. It also is increasingly recognized that NMBAs can cause harm, particularly critical illness polyneuromyopathy (CIPM), when used for prolonged periods or in septic shock. In this review, we address several practical considerations for clinicians who use NMBAs in their practice. Ultimately, we conclude that NMBAs should be considered a lung protective adjuvant in early ARDS and that clinicians should consider using an alternative NMBA to the aminosteroids in septic shock with less severe lung injury pending further studies.

Original languageEnglish (US)
JournalAnnals of Intensive Care
Volume2
Issue number1
DOIs
StatePublished - 2012

Fingerprint

Neuromuscular Blocking Agents
Critical Illness
Adult Respiratory Distress Syndrome
Lung Injury
Septic Shock
Intensive Care Units
Lung
Publications
Pneumonia
Guidelines
Mortality

Keywords

  • Adult
  • Cisatracurium
  • Neuromuscular blocking agents
  • Neuromuscular nondepolarizing agents
  • Polyneuropathies
  • Respiratory distress syndrome
  • Septic
  • Shock
  • Status asthmaticus

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

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abstract = "Neuromuscular blocking agents (NMBAs), or {"}paralytics,{"} often are deployed in the sickest patients in the intensive care unit (ICU) when usual care fails. Despite the publication of guidelines on the use of NMBAs in the ICU in 2002, clinicians have needed more direction to determine which patients would benefit from NMBAs and which patients would be harmed. Recently, new evidence has shown that paralytics hold more promise when used in carefully selected lung injury patients for brief periods of time. When used in early acute respiratory distress syndrome (ARDS), NMBAs assist to establish a lung protective strategy, which leads to improved oxygenation, decreased pulmonary and systemic inflammation, and potentially improved mortality. It also is increasingly recognized that NMBAs can cause harm, particularly critical illness polyneuromyopathy (CIPM), when used for prolonged periods or in septic shock. In this review, we address several practical considerations for clinicians who use NMBAs in their practice. Ultimately, we conclude that NMBAs should be considered a lung protective adjuvant in early ARDS and that clinicians should consider using an alternative NMBA to the aminosteroids in septic shock with less severe lung injury pending further studies.",
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