PRACTICE PARAMETERS FOR SUSTAINED NEUROMUSCULAR BLOCKADE IN THE ADULTCRITICALLY ILL PATIENT - AN EXECUTIVE SUMMARY

Objective: The development of practice parameters for achieving sustai ned neuromuscular blockade in the adult critically ill patient for the purpose of guiding clinical practice. Participants: A task force of m ore than 40 experts in disciplines related to the use of neuromuscular blocking agents in the intensive care unit was convened from the memb ership of the American College of Critical Care Medicine (ACCM) and th e Society of Critical Care Medicine (SCCM). Evidence: The task force m embers provided the personal experience and determined the published l iterature (MEDLINE articles, textbooks, pharmacopeias, etc.) from whic h consensus would be sought. Published literature was reviewed and cla ssified into one of four predetermined categories, according to study design and scientific value. Consensus Process: The task force met sev eral times as a whole, and numerous times in smaller groups by telecon ference, over a 1-yr period to identify the pertinent literature and a rrive at consensus recommendations for the whole task force to discuss . Consideration was given to the relationship between the weight of sc ientific information and the experts' viewpoints. Over the next year, draft documents were composed by a task force steering committee and d ebated by the task force members until consensus was reached by nomina l group process. The task force draft was then reviewed, assessed, and edited by the Board of Regents of the ACCM. After steering committee approval, the draft document was reviewed and approved by the SCCM Cou ncil. Data Synthesis: To facilitate rapid communication of the three r ecommendations contained within the complete and unabridged practice p arameter document, an executive summary was prepared for publication b y the ACCM Board of Regents, and this executive summary was approved b y the task force steering committee and the SCCM Executive Council. Co nclusions: A consensus of experts provided three recommendations with supporting data for achieving sustained neuromuscular blockade in crit ically ill patients: a) pancuronium is the preferred neuromuscular blo cking agent for most critically ill patients; b) vecuronium is the pre ferred neuromuscular blocking agent for those patients with cardiac di sease or hemodynamic instability in whom tachycardia may be deleteriou s; c) patients receiving neuromuscular blocking agents should be appro priately assessed for the degree of blockade that is being sustained. This executive summary selectively presents supporting information and is not intended as a substitute for the complete document.