While the patterns of use of neuromuscular blocking agents (NMBAs) in critically ill patients have undergone changes over the past decade, NMBAs are still used in the intensive care unit to facilitate mechanical ventilation. Prior to the initiation of neuromuscular blockade (NMB), clinicians should confirm that nonpharmacologic and pharmacologic strategies have not alleviated the need for NMB therapy. Recommended agents for use are pancuronium or vecuronium in hemodynamic instability.17 In patients receiving NMB therapy, the FDA recommends and clinical studies support an improved outcome with the use of peripheral nerve stimulation monitoring. There continues to be a need to provide education to health care clinicians regarding the dosing, monitoring, and unpredictable effects of NMB therapy.
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