POSTAL SURVEY ON THE LONG-TERM USE OF NEUROMUSCULAR BLOCK IN THE INTENSIVE-CARE

Objective: To assess the long-term use of neuromuscular blocking (NMB) agents in intensive care, especially with reference to the potential problems of the long-term use of NMB drugs in the intensive care unit (ICU). Method: A postal survey questionnaire was sent to 409 ICUs in G reat Britain. Results: Two hundred thirty-eight completed questionnair es were returned and analysed. Mast ICUs were anaesthetist-led (85.8%) will only five ICUs being staffed by full-time intensivists. Facilita tion of mechanical ventilation and increased intracranial pressure wer e the main indications for the prolonged use of neuromuscular blockade . Atracurium and vecuronium (83%) were administered most commonly by b olus alone (13.8%), bolus followed by continuous infusion (23.9%) or c ontinuous infusion only (60.9%). The most frequently cited criteria fo r the use of either vecuronium or stracurium were their pharmacokineti cs and haemodynamic stability. Neuro muscular block was most commonly monitored clinically (91.7%), with only 8.3% of the responders using a peripheral nerve stimulator, All responders indicated the concomitant use of sedatives (propofol/midazolam alone or in combination in combi nation in 89.4% of responders) and/or opioids (morphine, fentanyl or a lfentanil in 74.8% of respondents) with muscle relaxants. Conclusion: Most responders agreed that while neuromuscular block in the ICU popul ation may provide advantages, it cannot be considered benign. Indeed, a great majority consider that NMB agents should be used only as a las t option and for as short a period as possible.