Functional recovery after neuromuscular blockade in mechanically ventilated critically ill patients.

Abstract

BACKGROUND:

An estimated 24% to 70% of individuals have prolonged paralysis or severe weakness after receiving neuromuscular blocking agents (NMBAs) when therapy is terminated.

OBJECTIVES:

The purposes of this study were to (1) evaluate the relationship between recovery of neuromuscular transmission (NMT) and functional muscle activity after NMBA administration; (2) evaluate the relationship between delayed recovery of NMT or muscle activity and functional performance; and (3) determine the predictors of delayed recovery of NMT, muscle activity, and functional performance.

METHODS:

This was a multisite study using a prospective, nonexperimental, descriptive design with convenience sampling techniques. Instruments used included a five-point muscle score, Actigraph, and peripheral nerve stimulator.

RESULTS:

Key findings were as follows: (1) NMT returned promptly, whereas muscle activity remained severely depressed; (2) only two subjects (5%) recovered functional performance within 24 hours; (3) degree of muscle weakness immediately after neuromuscular blockade was associated with prolonged time to extubation and mobility; and (4) predictors of delayed recovery included cumulative dose of aminosteroid NMBAs, age, and renal function.

CONCLUSION:

Prolonged recovery of muscle activity and extreme weakness may occur despite brisk recovery of NMT after neuromuscular blockade.

• Authors: Janet G Whetstone Foster, Angela P Clark
• Journal: Heart & lung : the journal of critical care (Heart Lung) 2006 May-Jun Vol. 35 Issue 3 Pg. 178-89 ISSN: 0147-9563 [Print] United States
• PMID: 16701112 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Neuromuscular Blocking Agents

Topics

• Adult
• Aged
• Aged, 80 and over
• Drug Synergism
• Female
• Humans
• Linear Models
• Male
• Middle Aged
• Muscle Weakness (chemically induced, prevention & control)
• Neuromuscular Blockade (adverse effects)
• Neuromuscular Blocking Agents (adverse effects, pharmacokinetics)
• Neuromuscular Junction Diseases (chemically induced, prevention & control)
• Prospective Studies
• Recovery of Function
• Respiration, Artificial