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 language | English (US) |
|---|---|
| Journal | Annals of Intensive Care |
| Volume | 2 |
| Issue number | 1 |
| DOIs | |
| State | Published - 2012 |
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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
A fresh look at paralytics in the critically ill : Real promise and real concern. / Price, David; Kenyon, Nicholas; Stollenwerk, Nicholas.
In: Annals of Intensive Care, Vol. 2, No. 1, 2012.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A fresh look at paralytics in the critically ill
T2 - Real promise and real concern
AU - Price, David
AU - Kenyon, Nicholas
AU - Stollenwerk, Nicholas
PY - 2012
Y1 - 2012
N2 - 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.
AB - 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.
KW - Adult
KW - Cisatracurium
KW - Neuromuscular blocking agents
KW - Neuromuscular nondepolarizing agents
KW - Polyneuropathies
KW - Respiratory distress syndrome
KW - Septic
KW - Shock
KW - Status asthmaticus
UR - http://www.scopus.com/inward/record.url?scp=84871106140&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84871106140&partnerID=8YFLogxK
U2 - 10.1186/2110-5820-2-43
DO - 10.1186/2110-5820-2-43
M3 - Article
C2 - 23062076
AN - SCOPUS:84871106140
VL - 2
JO - Annals of Intensive Care
JF - Annals of Intensive Care
SN - 2110-5820
IS - 1
ER -