Neuromuscular blockade: is it still useful in the ICU?

Neuromuscular relaxants may be administered to ICU patients for days or weeks. The most frequent indications are facilitation of mechanical ventilation and management of neurosurgical patients after severe head injury. Tachyphylaxis can be observed in ICU patients but the major problem remains the prolonged weakness which can occur after long-term administration of muscle relaxants. The mechanisms are still poorly understood and under investigation. Although neuromuscular monitoring provides guidelines for the administration of muscle relaxants in critically ill patients, it does not prevent the development of a myopathy.