Tezcan Büşra, Turan Sema, Özgök Ayşegül
Clinic of Anaesthesiology and Reanimation, Department of Intensive Care, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
Clinic of Anaesthesiology and Reanimation, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
Turk J Anaesthesiol Reanim. 2019 Aug;47(4):273-281. doi: 10.5152/TJAR.2019.33269. Epub 2019 Jan 24.
Neuromuscular blocking agents can be used for purposes such as eliminating ventilator-patient dyssynchrony, facilitating gas exchange by reducing intra-abdominal pressure and improving chest wall compliance, reducing risk of lung barotrauma, decreasing contribution of muscles to oxygen consumption by preventing shivering and limiting elevations in intracranial pressure caused by airway stimulation in patients supported with mechanical ventilation in intensive care units. Adult Respiratory Distress Syndrome (ARDS), status asthmaticus, increased intracranial pressure and therapeutic hypothermia following ventricular fibrillation-associated cardiac arrest are some of clinical conditions that can be sustained by neuromuscular blockade. Appropriate indication and clinical practice have gained importance considering side effects such as ICU-acquired weakness, masking seizure activity and longer durations of hospital and ICU stays. We mainly aimed to review the current literature regarding neuromuscular blockade in up-to-date clinical conditions such as improving oxygenation in early ARDS and preventing shivering in the therapeutic hypothermia along with summarising the clinical practice in adult ICU in this report.
神经肌肉阻滞剂可用于多种目的,如消除呼吸机与患者之间的不同步,通过降低腹内压和改善胸壁顺应性来促进气体交换,降低肺气压伤风险,通过防止寒战以及限制重症监护病房中接受机械通气患者因气道刺激引起的颅内压升高,减少肌肉对氧消耗的贡献。成人呼吸窘迫综合征(ARDS)、哮喘持续状态、颅内压升高以及心室颤动相关性心脏骤停后的治疗性低温等,都是可通过神经肌肉阻滞维持的一些临床状况。考虑到诸如重症监护病房获得性肌无力、掩盖癫痫活动以及延长住院和重症监护病房停留时间等副作用,恰当的适应证和临床实践变得愈发重要。在本报告中,我们主要旨在回顾关于神经肌肉阻滞在诸如改善早期ARDS氧合以及治疗性低温中预防寒战等最新临床状况方面的当前文献,同时总结成人重症监护病房的临床实践。