Neuromuscular Blockade (Paralytics) and Monitoring Neuromuscular blockade caring for patients with severe ARDS and may reduce mortality. • Improved ventilator synchrony / prevention of patient induced lung injury (e.g. double-stacking) • Decreased oxygen consumption However, NMB can also be harmful: • Prolonged/excessive NMB is associated with neuromuscular weakness/muscle loss • Prolonged/deeper sedation is associated with increased risk of delirium, neurocognitive impairment • NMB is associated with increased risk of pressure injuries, corneal abrasions, & DVTs Choice of Neuromuscular Blocker (NMB) - All NMBs are non-depolarizing and administered by continuous infusion: • Cisatrocurium — Metabolized by esterases/spontaneously in plasma (Hoffman elimination); not renally or hepatically cleared. More expensive. • Rocuronium - Mostly hepatic metabolism, though with renal/biliary excretion of metabolites. Avoid in renal failure. • Vecuronium - 40% renal, 60% biliary clearance. Avoid in liver/renal failure. Monitoring: • EEG/Bispectral Index (BIS) Monitoring - Use EEG/BIS monitor to ensure sedation depth is adequate • Train of Four (TOF) Monitoring - Use TOF monitor to ensure NMB is at lowest dose possible by Nick Mark MD @nickmmark #Neuromuscular #Blockade #NMB #Paralytics #Monitoring #neurology #criticalcare #ARDS #management
