Postal survey on the long-term use of neuromuscular block in the intensive care

Abstract

Objective: To assess the long-term use of neuromuscular blocking (NMB) agents in intensive care, especially with reference to the potential problems of the long-term use of NMB drugs in the intensive care unit (ICU).

Method: A postal survey questionnaire was sent to 409 ICUs in Great Britain.

Results: Two hundred thirty-eight completed questionnaires were returned and analysed. Most ICUs were anaesthetist-led (85.8%) with only five ICUs being staffed by full-time intensivists. Facilitation of mechanical ventilation and increased intracranial pressure were the main indications for the prolonged use of neuromuscular blockade. Atracurium and vecuronium (83%) were administered most commonly by bolus alone (13.8%), bolus followed by continuous infusion (23.9%) or continuous infusion only (60.9%). The most frequently cited criteria for the use of either vecuronium or stracurium were their pharmacokinetics and haemodynamic stability. Neuromuscular block was most commonly monitored clinically (91.7%), with only 8.3% of the responders using a peripheral nerve stimulator. All responders indicated the concomitant use of sedatives (propofol/midazolam alone or in combination in 89.4% of responders) and/or opioids (morphine, fentanyl or alfentanil in 74.8% of respondents) with muscle relaxants.

Conclusion: Most responders agreed that while neuromuscular block in the ICU population may provide advantages, it cannot be considered benign. Indeed, a great majority consider that NMB agents should be used only as a last option and -for as short a period as possible.