title: Corticosteroids and neuromuscular blockers in development of critical illness neuromuscular abnormalities: A historical review.
abstract: Weakness is common in critically ill patients, associated with prolonged mechanical ventilation and increased mortality. Corticosteroids and neuromuscular blockade (NMB) administration have been implicated as etiologies of acquired weakness in the intensive care unit. Medical literature since the 1970s is replete with case reports and small case series of patients with weakness after receiving high-dose corticosteroids, prolonged NMB, or both. Several risk factors for weakness appear in the early literature, including large doses of steroids, the dose and duration of NMB, hyperglycemia, and the duration of mechanical ventilation. With improved quality of data, however, the association between weakness and steroids or NMB wanes. This may reflect changes in clinical practice, such as a reduction in steroid dosing, use of cisatracurium besylate instead of aminosteroid NMBs, improved glycemic control, or trends in minimizing mechanical ventilatory support. Thus, based on the most recent and high-quality literature, neither corticosteroids in commonly used doses nor NMB is associated with increased duration of mechanical ventilation, the greatest morbidity of weakness. Minimizing ventilator support as soon as the patient's condition allows may be associated with a reduction in weakness-related morbidity.
authors.affiliation: Division of Pulmonary, Critical Care, Allergy and Sleep Medicine and Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC. Electronic address: susanrwilcoxmd@gmail.com.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Wilcox
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D003422:Critical Care / Q000266:history; D016638:Critical Illness; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007362:Intensive Care Units; D018908:Muscle Weakness / Q000139:chemically induced / Q000266:history*; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects; D012121:Respiration, Artificial; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones; D009466:Neuromuscular Blocking Agents
keywords: Corticosteroids; Myopathy; Neuromuscular blockade; Polyneuropathy; Weakness