Neuromuscular blocking agents in neurointensive care.
BACKGROUND
Intensive care treatment of patients with severe head injury is aimed at preventing secondary injury. One of the cornerstones in this treatment is sedation and ventilation. Use of Neuromuscular Blocking Agents (NBA) has gained widespread use as part of the protocol for maintaining normal intracranial pressure values, without class 1 evidence for the efficacy of the treatment.


METHODS
We examined data of the use of NBA as infusion during ventilator treatment, and IntraCranial Pressure (ICP) measurements in the database from the international multicenter randomized double blind trial of the NMDA receptor antagonist Selfotel. No specific mode of sedation was recommended in the study protocol.


RESULTS
Of the 427 patients enrolled in the study 326 had a full data set, 138 received NBA during their stay in the ICU. There were no statistical difference in demographic data between the two groups. During their stay in the ICU, patients who received NBA had a median of 13.5 hours with a recorded ICP above 20 mm Hg, patients who did not receive NBA had a median of 6.5 hours with ICP above 20 mm Hg (p < 0.05).


CONCLUSIONS
Our data challenges the concept of using NBA as part of a routine sedation strategy in treatment of patients with severe head injury.
Juul
N
N
Division of Neurosurgery, University of California San Diego, San Diego, USA.
Morris
G F
GF
Marshall
S B
SB
Marshall
L F
LF
D000328:Adult; D001929:Brain Edema / Q000188:drug therapy*; D001930:Brain Injuries / Q000188:drug therapy*; D016292:Procedural Sedation; D003422:Critical Care; D004311:Double-Blind Method; D018846:Excitatory Amino Acids / Q000037:antagonists & inhibitors*; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage* / Q000009:adverse effects; D010875:Pipecolic Acids / Q000008:administration & dosage*; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome
D018846:Excitatory Amino Acids; D009466:Neuromuscular Blocking Agents; D010875:Pipecolic Acids; C053672:selfotel