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


METHODS
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.


CONCLUSIONS
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.
University Department of Anaesthesia, Leicester Royal Infirmary, UK.
B L
BL
Appadu
J M
JM
Greiff
J P
JP
Thompson
D000701:Analgesics, Opioid / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D006113:United Kingdom
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents