From: Neuromuscular blockade management in the critically Ill patient
Clinical practice(s) | Strength of Recommendation |
---|---|
• Scheduled eye care with lubrication and eyelid closure | Strong recommendation |
• Continuous infusion of NMBA rather than intermittent boluses • Avoid use in status asthmaticus • Trial of NMBA in life-threatening situations with hypoxemia, respiratory acidosis, and hemodynamic compromise • May be used to manage overt shivering in therapeutic hypothermia • PNS with inclusive clinical assessment may be a useful tool for determining the depth of blockade • PNS should not be used alone (without clinical assessments) in patients receiving a continuous infusion of NMBAs • Implementation of a structured physiotherapy regimen • Target blood glucose level < 180 mg/dL • Dose NMBA based on ideal body weight or adjusted boy weight (rather than actual) | Weak recommendation |
• PNS can be used with clinical assessment in patients undergoing therapeutic hypothermia • Protocols should be utilized to guide NMBA administration in patients undergoing therapeutic hypothermia • Analgesic and sedative drugs should be used before and during neuromuscular blockade • Implement measures to reduce risk of unintended extubation in patients receiving NMBAs • Reduce dosing in patients with myasthenia gravis based on PNS use • Discontinue NMBAs prior to determining brain death | Good practice based on expert opinion with insufficient evidence |