[Indications and uses of neuromuscular blocking agents in the ICU]

Although many questions are still debated, some recommendations can be formulated regarding the use of neuromuscular blocking agents in the ICU. A transient curarization can be used during brief diagnostic or therapeutic procedures in order to avoid haemodynamic consequences of deep sedation. A volume controlled ventilation has to be used during the procedure. In ARDS patients, a prolonged curarization of 48 h or more is beneficial regarding systemic oxygenation, even in patients well adapted to their ventilator. The use of cisatracurium should be recommended in this context. The depth of curarization has to be checked by using a train of four stimulation at the corugator supercilii with an endpoint of 2/4 responses. A recovery from curarization should be daily envisaged if possible, in order to check the depth of the underlying sedation. In brain injured patients, a curarization can be envisaged if adaptation to the ventilator remains difficult or if normothermia or moderate hypothermia, if indicated, cannot be obtained. However, these attitudes are not based on specific data at the present time.