Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient.

Area of Science:

• Critical Care Medicine
• Pharmacology
• Clinical Practice Guidelines

Background:

• The 2002 guidelines for sustained neuromuscular blockade in critically ill adults needed updating.
• Neuromuscular-blocking agents (NMBAs) are used in critical care for various indications.
• Evidence-based guidelines are essential for optimizing NMBA use and patient outcomes.

Purpose of the Study:

• To update the 2002 clinical practice guidelines for sustained neuromuscular blockade in adult critically ill patients.
• To provide evidence-based recommendations for the use of NMBAs in critical care settings.
• To address key questions regarding NMBA administration, monitoring, and adjunct therapies.

Main Methods:

• A multidisciplinary Task Force reviewed available evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.
• Recommendations, suggestions, and good practice statements were developed for 21 clinical questions.
• The process involved teleconferences, face-to-face meetings, and email communication.

Main Results:

• A strong recommendation was made for scheduled eye care (lubrication and closure) for patients on continuous NMBA infusions.
• Ten weak recommendations were issued, including NMBA use in ARDS, status asthmaticus, shivering, and weight-based dosing.
• No recommendations were made for nine topics due to insufficient evidence, and six good practice statements were developed.

Conclusions:

• Scheduled eye care is strongly recommended for patients receiving continuous neuromuscular blockade.
• The updated guidelines provide nuanced recommendations for NMBA use in specific critical care situations.
• Further research is needed in areas where evidence is lacking to inform future guideline revisions.