NEUROMUSCULAR BLOCKERS (NMBs) MAY BE USED IN THE ICU FOR:1

Facilitating mechanical ventilation by stopping spontaneous breathing efforts and preventing patient-ventilator dyssynchrony

Important Considerations When Caring for a Patient on a Neuromuscular Blocker

The ICU patient on a neuromuscular blocking agent is completely paralyzed (i.e., unable to breathe, cannot blink, no swallowing or gag reflex, etc.). They are dependent on the ICU team to protect them from potential complications. The following are recommendations to provide patient safety:

  • Provide adequate sedation and analgesia (NMBs have no sedative or analgesic properties; always use with a sedative for amnesia to minimize patient recall)
  • Use a twitch monitor to assess the patient’s train-of-four responses and document the level of paralysis
  • Always deliver the lowest effective dose of the NMB; to ensure the dose is not excessive, allow some muscle stimulation to occur
  • Protect the patient’s eyes with the use of artificial tears
  • Position the patient so as to protect pressure points
  • Address deep vein thrombosis
    • Sequential compression boots
    • Chemical anticoagulation
  • Prevent stress ulcers
  • Administer mouth washes
  • Elevate the head of the bed to prevent ventilator-associated pneumonia
  • Monitor pupillary reflexes to assess neurologic status
  • Schedule a neuromuscular blocker “holiday” every 12-24 hours to assess need for continued use
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