Neuromuscular blockade in Critical Care Aim To provide guidance on the administration and monitoring of neuromuscular blockade in Critical Care Scope All adult patients in intensive care receiving continuous neuromuscular blockade ID: 930489
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Consider continuous neuromuscular blocking agents for patients with:
Neuromuscular blockade in Critical Care
Aim To provide guidance on the administration and monitoring of neuromuscular blockade in Critical CareScope All adult patients in intensive care receiving continuous neuromuscular blockade
Adapted from Queen Alexandra hospital Portsmouth – M MacKinnon 28.03.2017
Raigmore Critical Care Guidelines
Ensure deeply sedated (e.g. RASS-5) then test baseline train-of-four (TOF) response.
Note the current required: should be minimum needed for maximum response.
Discuss with ICU Consultant, check no contraindications, and choice of drug
Give iv loading dose: atracurium 0.3-0.6mg/kg over 1 minuteStarte Iv infusion: atracurium 0.3-0.6mg/kg/hr
Severe respiratory failure requiring advanced ventilation strategiesSevere head injury & raised intracrainial pressure
Shivering during targeted temperature managementUncontrolled muscle spasm or rigidity
Check TOF every 30minsutes until infusion rate has been stable for 2 testsWhen infusion rate has been stable for 2 tests, check TOF routinely every 4 hours.
If more than 2 twitches seen or felt:Increase atracurium infusion rate by 10%Consider bolus dose (discuss with doctor)Repeat TOF monitoring in 30 mins
If fewer than 2 twitches seen or felt:Reduce atracurium infusion rate by 10%Repeat TOF monitoring in 30 mins
Remember
Daily break in NMBA if condition allowsEye and pressure area carePassive physiotherapyAdequate DVT prophylaxis