RT Book, Section
A1 JURADO, LESLY
A1 ALLISON, TERESA A.
A1 GULBIS, BRIAN
A1 FARRINGTON, ELIZABETH
A2 Cohen, Henry
SR Print(0)
ID 1112258017
T1 Neuromuscular Blocking Agents
T2 Casebook in Clinical Pharmacokinetics and Drug Dosing
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071628358
LK accesspharmacy.mhmedical.com/content.aspx?aid=1112258017
RD 2024/04/23
AB Approximately  80  percent  of  critically  ill  intensive  care  patients  require  mechanical  ventilation,  thus  administration  of  a  one-time-only  dose  of  a  neuromuscular  blocking  agent  (NMBA)  is  common.  They  are  used  to  facilitate  endotracheal  intubation  as  they  prevent  laryngospasm  and  keep  the  patient  from  resisting  the  procedure.  These  agents  should  not  be  used,  however,  if  the  normalcy  of  the  airway  and  the  ability  to  successfully  accomplish  bag-mask  ventilation  and  endotracheal  intubation  are  questionable.  Once  intubated,  only  1  percent  to  15  percent  of  ICU  patients  are  treated  with  continuous  infusion  or  scheduled  NMBAs  (1%,  surgical  ICU;  <10%  medical  ICU;  ~15%  trauma  and  pediatric  ICU).1  Aggressive  use  of  analgesia  and  sedation  is  essential  initially,  and  NMBAs  are  reserved  for  patients  who  fail  to  meet  desired  goals  despite  maximum  sedative  therapy.  The  clinical  practice  guideline  for  sustained  neuromuscular  blockade  published  by  the  Society  of  Critical  Care  Medicine  states  that  “NMBAs  should  be  used  in  an  adult  patient  in  an  ICU  to  manage  ventilation,  manage  increased  ICP,  treat  muscle  spasms,  and  decrease  oxygen  consumption  ONLY  when  all  other  means  have  been  tried  without  success.”2