title: A retrospective analysis of long-term use of nondepolarizing neuromuscular blocking agents in the intensive care unit, and guidelines for drug selection.
abstract: Nondepolarizing neuromuscular blocking agents (NNMBAs) are frequently administered to patients in the intensive care unit (ICU). We conducted a retrospective study of patients in intensive care who received infusions (> 48 hrs) of commonly used NNMBAs. The goals were to describe NNMBA use in our ICUs, determine patient characteristics, and assess the cost of the individual drugs. We found that atracurium was prescribed for 68% of study patients; 68% of the patients did not have renal, hepatic, or cardiovascular disease; dosages of NNMBAs varied; a statistically significant increase in dosage requirements over time occurred with atracurium; assessment of neuromuscular blockade was 100% subjective; and 41% and 17% of patients receiving atracurium and vecuronium, respectively, experienced prolonged neuromuscular weakness documented subjectively. As a result of this study, guidelines for agent selection were developed to facilitate cost effective use of NNMBA in our ICUs. Using these guidelines would potentially significantly decrease drug expenditures in this setting.
authors.affiliation: St. Paul-Ramsey Medical Center, MN 55101-2595.
authors.forename: D M
authors.initials: DM
authors.lastname: Clarens
authors.forename: K J
authors.initials: KJ
authors.lastname: Kelly
authors.forename: S S
authors.initials: SS
authors.lastname: Gilliland
authors.forename: P K
authors.initials: PK
authors.lastname: Kohls
authors.forename: A
authors.initials: A
authors.lastname: Nahum
authors.forename: K
authors.initials: K
authors.lastname: Vance-Bryan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001279:Atracurium / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D002675:Child, Preschool; D017046:Cost Savings; D016527:Drug Costs; D017723:Drug Utilization Review; D005260:Female; D006745:Hospital Bed Capacity, 300 to 499; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use*; D010197:Pancuronium / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D013997:Time Factors; D014673:Vecuronium Bromide / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D014673:Vecuronium Bromide; D010197:Pancuronium