Sedation, analgesia, and neuromuscular blockade for high-frequency oscillatory ventilation

Abstract

A multidisciplinary, structured approach that is based on the considerations described should help achieve optimal results in this challenging patient population.

Infusions of rocuronium and cisatracurium exert different effects on rat diaphragm function

“…Electromyographic measurements confirmed that diaphragm activity was silenced in the different groups. The effective doses of rocuronium and cisatracurium used in this study are comparable with those used by clinicians in the ICU (one to three twitches with train-of-four testing) [3]. We chose rocuronium because it is the latest available aminosteroidal agent which has become popular for providing excellent intubating conditions in ICU patients [21].…”

“…NMBA use is a known trigger for myopathy development which can lead to prolonged MV and intensive care unit (ICU) stay [1,5]. After different case reports, this myopathy was originally attributed to the use of aminosteroidal NMBAs [3,6]. However, benzylisoquinoline agents have also been associated with myopathy development [7,8].…”

“…A large recent prospective cohort study showed that these agents are used in 13% of MV patients with a mean duration of 2 days [2]. In patients with acute respiratory distress syndrome the frequency (± 25%) and duration of NMBA use is even higher [3]. Both aminosteroidal and benzylisoquinoline NMBAs are being used for this purpose, and clinical preference for a specific non-depolarizing NMBA is often based on the pharmacokinetic properties [4].…”

Mechanical ventilation during acute lung injury: Current recommendations and new concepts

“…These studies have shown that HFO is technically feasible and generally tolerated, resulting in improvements in oxygenation [107][108][109][110]. Complications reported with HFO are relatively infrequent and include barotrauma [107,110,111], hemodynamic compromise [108,110], mucus inspissations resulting in endotracheal tube occlusion or refractory hypercapnia, and increased use of sedation or neuromuscular blocking agents (NMBA) [107,108,111,112].…”

Sedation and ParalysisDiscussion

“…[68][69][70] The use of NMBAs is especially helpful during non-conventional ventilatory strategies such as permissive hypercapnia, prone positioning, use of high levels of PEEP, and high frequency oscillatory ventilation. [71][72][73] In addition, elimination of spontaneous inspiratory efforts reduces transpulmonary pressures, thereby potentially minimizing the risk of overstretch and strain on alveoli, compared with patients making vigorous inspiratory efforts 74,75 ( Fig. 1).…”