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7.3 - Sedation and Neuromuscular Blockade in Intensive Care

from Section 7 - Comfort and Recovery

Published online by Cambridge University Press:  27 July 2023

By
Edward Rintoul  and
Jeff Philips
Edited by
Ned Gilbert-Kawai ,
Debashish Dutta  and
Carl Waldmann
Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. Goldilocks principle – always aim for just the right amount of sedation, comfort without coma.

  2. 2. Use of sedation holds/‘holidays’ can reduce the length of ventilator days.

  3. 3. Sedation protocols vary between institutions, but all rely on regular assessment of depth of sedation with standardised scoring systems.

  4. 4. Use of neuromuscular blockade in critical care has modest association with neuromuscular dysfunction seen in critical illness weakness.

  5. 5. Use of early neuromuscular blockade in moderate to severe acute respiratory distress syndrome has been shown to reduce mortality.

Keywords

sedationneuromuscular blockadesedation holidayARDS
Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
 , pp. 660 - 662
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

Murray, M, DeBlock, H, Erstad, B, et al. Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med 2016;44:2079–98.CrossRefGoogle ScholarPubMed
National Heart, Lung, and Blood Institute PETAL Clinical Trials Network; Moss, M, Huang, DT, Brower, RG, et al. Early neuromuscular blockade in the acute respiratory distress syndrome. N Engl J Med 2019;380:1997–2008.Google ScholarPubMed
Price, DR, Mikkelsen, ME, Umscheid, CA, Armstrong, EJ. Neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness: a systematic review and meta-analysis. Crit Care Med 2016;44:2070–8.CrossRefGoogle ScholarPubMed
Shehabi, Y, Howe, BD, Bellomo, R, et al. Early sedation with dexmedetomidine in critically ill patients. N Engl J Med 2019;380:2506–17.CrossRefGoogle ScholarPubMed
Whitehouse, T, Snelson, C, Grounds, M (eds). 2014. Intensive Care Society review of best practice for analgesia and sedation in the critical care. www.ics.ac.uk/Society/Guidance/PDFs/Analgesia_and_SedationGoogle Scholar

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