title: Neuromuscular blockade and skeletal muscle weakness in critically ill patients: time to rethink the evidence?
abstract: Neuromuscular blocking agents are commonly used in critical care. However, concern after observational reports of a causal relationship with skeletal muscle dysfunction and intensive care-acquired weakness (ICU-AW) has resulted in a cautionary and conservative approach to their use. This integrative review, interpreted in the context of our current understanding of the pathophysiology of ICU-AW and integrated into our current conceptual framework of clinical practice, challenges the established clinical view of an adverse relationship between the use of neuromuscular blocking agents and skeletal muscle weakness. In addition to discussing data, this review identifies potential confounders and alternative etiological factors responsible for ICU-AW and provides evidence that neuromuscular blocking agents may not be a major cause of weakness in a 21st century critical care setting.
authors.affiliation: Institute for Human Health and Performance, University College London, London, UK. zudin.puthucheary.09@ucl.ac.uk
authors.forename: Zudin
authors.initials: Z
authors.lastname: Puthucheary
authors.forename: Jaikirty
authors.initials: J
authors.lastname: Rawal
authors.forename: Gamunu
authors.initials: G
authors.lastname: Ratnayake
authors.forename: Stephen
authors.initials: S
authors.lastname: Harridge
authors.forename: Hugh
authors.initials: H
authors.lastname: Montgomery
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hart
mesh_terms: D000818:Animals; D016292:Procedural Sedation / Q000009:adverse effects; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D004195:Disease Models, Animal; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D018908:Muscle Weakness / Q000139:chemically induced* / Q000209:etiology; D018482:Muscle, Skeletal / Q000187:drug effects*; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects; D051381:Rats
chemical_list: D009466:Neuromuscular Blocking Agents