Division of Pulmonary, Critical Care and Sleep Medicine, Univ, of California, Davis, 4150V, Street, Suite 3400, Sacramento, CA 95817, USA.
Ann Intensive Care. 2012 Oct 12;2(1):43. doi: 10.1186/2110-5820-2-43.
Neuromuscular blocking agents (NMBAs), or "paralytics," often are deployed in the sickest patients in the intensive care unit (ICU) when usual care fails. Despite the publication of guidelines on the use of NMBAs in the ICU in 2002, clinicians have needed more direction to determine which patients would benefit from NMBAs and which patients would be harmed. Recently, new evidence has shown that paralytics hold more promise when used in carefully selected lung injury patients for brief periods of time. When used in early acute respiratory distress syndrome (ARDS), NMBAs assist to establish a lung protective strategy, which leads to improved oxygenation, decreased pulmonary and systemic inflammation, and potentially improved mortality. It also is increasingly recognized that NMBAs can cause harm, particularly critical illness polyneuromyopathy (CIPM), when used for prolonged periods or in septic shock. In this review, we address several practical considerations for clinicians who use NMBAs in their practice. Ultimately, we conclude that NMBAs should be considered a lung protective adjuvant in early ARDS and that clinicians should consider using an alternative NMBA to the aminosteroids in septic shock with less severe lung injury pending further studies.
神经肌肉阻滞剂（NMBA），也被称为“瘫痪剂”，通常在重症监护病房（ICU）中最病重的患者常规治疗失败时使用。尽管 2002 年就已经发布了关于 ICU 中 NMBA 使用的指南，但临床医生仍需要更多的指导，以确定哪些患者可以从 NMBA 中受益，哪些患者会受到伤害。最近，新的证据表明，在经过精心选择的肺损伤患者中，短期使用瘫痪剂有更大的希望。在早期急性呼吸窘迫综合征（ARDS）中，NMBA 有助于建立肺保护策略，从而改善氧合，减少肺和全身炎症，并可能降低死亡率。人们也越来越认识到，NMBA 会造成伤害，尤其是在长时间使用或脓毒性休克时会导致严重的危重病多发性神经病（CIPM）。在这篇综述中，我们讨论了临床医生在实践中使用 NMBA 时需要考虑的几个实际问题。最终，我们得出结论，NMBA 应被视为早期 ARDS 的肺保护辅助剂，并且在进一步研究之前，对于肺损伤程度较轻的脓毒性休克患者，临床医生应考虑使用非氨基甾体类 NMBA 替代物。
