Should ICU patients receive muscle relaxants?

Neuromuscular blocking agents (NMBAs) are used in many critically ill patients, although their use is declining. NMBAs are designed for short term use in the operating theatre, and there are few studies in the critical care setting of either efficacy or safety, in particular their metabolism may be impaired by organ dysfunction. Weakness associated with critical illness is multifactorial, but in many cases is associated with myopathies and neuropathies. The possible role of NMBAs in the development of weakness is unclear, but there is no proven link between the use of NMBAs and neuropathy or myopathy.