Neuromuscular Blockade and Skeletal Muscle Weakness in Critically Ill Patients: Time to Rethink the Evidence?

TY - JOUR

T1 - Neuromuscular Blockade and Skeletal Muscle Weakness in Critically Ill Patients

T2 - Time to Rethink the Evidence?

AU - Puthucheary, Zudin

AU - Rawal, Jaikirty

AU - Ratnayake, Gamunu

AU - Harridge, Stephen

AU - Montgomery, Hugh

AU - Hart, Nicholas

PY - 2012/5/1

Y1 - 2012/5/1

N2 - Neuromuscular blocking agents are commonly used in critical care. However, concern after observational reports of a causal relationship with skeletal muscle dysfunction and intensive care-acquired weakness (ICU-AW) has resulted n a cautionary and conservative approach to their use. This integrative review, interpreted in the context of our current understanding of the pathophysiology of ICU-AW and integrated into our current conceptual framework of clinical practice, challenges the established clinical view of an adverse relationship between the use of neuromuscular blocking agents and skeletal muscle weakness. In addition to discussing data, this review identifies potential con founders and alternative etiological factors responsible for ICU-AW and provides evidence that neuromuscular blocking agents may not be a major cause of weakness in a 21st century critical care setting.

AB - Neuromuscular blocking agents are commonly used in critical care. However, concern after observational reports of a causal relationship with skeletal muscle dysfunction and intensive care-acquired weakness (ICU-AW) has resulted n a cautionary and conservative approach to their use. This integrative review, interpreted in the context of our current understanding of the pathophysiology of ICU-AW and integrated into our current conceptual framework of clinical practice, challenges the established clinical view of an adverse relationship between the use of neuromuscular blocking agents and skeletal muscle weakness. In addition to discussing data, this review identifies potential con founders and alternative etiological factors responsible for ICU-AW and provides evidence that neuromuscular blocking agents may not be a major cause of weakness in a 21st century critical care setting.

KW - neuromuscular blockade

KW - intensive care unit-acquired weakness

KW - outcome

KW - INTENSIVE-CARE-UNIT

KW - RESPIRATORY-DISTRESS-SYNDROME

KW - CRITICAL ILLNESS POLYNEUROPATHY

KW - ACUTE QUADRIPLEGIC MYOPATHY

KW - ACUTE SEVERE ASTHMA

KW - MECHANICALLY VENTILATED PATIENTS

KW - GLUCOCORTICOID-INDUCED MYOPATHY

KW - ACUTE HYDROCORTISONE MYOPATHY

KW - LONG-TERM INFUSION

KW - BLOCKING-AGENTS

U2 - 10.1164/rccm.201107-1320OE

DO - 10.1164/rccm.201107-1320OE

M3 - Editorial

SN - 1073-449X

VL - 185

SP - 911

EP - 917

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 9

ER -