Shapiro B A, Warren J, Egol A B, Greenbaum D M, Jacobi J, Nasraway S A, Schein R M, Spevetz A, Stone J R
Crit Care Med. 1995 Sep;23(9):1601-5. doi: 10.1097/00003246-199509000-00022.
The development of practice parameters for achieving sustained neuromuscular blockade in the adult critically ill patient for the purpose of guiding clinical practice.
A task force of more than 40 experts in disciplines related to the use of neuromuscular blocking agents in the intensive care unit was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM).
The task force members provided the personal experience and determined the published literature (MEDLINE articles, textbooks, pharmacopeias, etc.) from which consensus would be sought. Published literature was reviewed and classified into one of four predetermined categories, according to study design and scientific value.
The task force met several times as a whole, and numerous times in smaller groups by teleconference, over a 1-yr period to identify the pertinent literature and arrive at consensus recommendations for the whole task force to discuss. Consideration was given to the relationship between the weight of scientific information and the experts' viewpoints. Over the next year, draft documents were composed by a task force steering committee and debated by the task force members until consensus was reached by nominal group process. The task force draft was then reviewed, assessed, and edited by the Board of Regents of the ACCM. After steering committee approval, the draft document was reviewed and approved by the SCCM Council.
To facilitate rapid communication of the three recommendations contained within the complete and unabridged practice parameter document, an executive summary was prepared for publication by the ACCM Board of Regents, and this executive summary was approved by the task force steering committee and the SCCM Executive Council.
A consensus of experts provided three recommendations with supporting data for achieving sustained neuromuscular blockade in critically ill patients: a) pancuronium is the preferred neuromuscular blocking agent for most critically ill patients; b) vecuronium is the preferred neuromuscular blocking agent for those patients with cardiac disease or hemodynamic instability in whom tachycardia may be deleterious; c) patients receiving neuromuscular blocking agents should be appropriately assessed for the degree of blockade that is being sustained. This executive summary selectively presents supporting information and is not intended as a substitute for the complete document.
制定用于指导临床实践的、在成年危重症患者中实现持续神经肌肉阻滞的实践参数。
从美国危重症医学学会（ACCM）和危重症医学会（SCCM）的成员中召集了一个由40多名重症监护病房中使用神经肌肉阻滞剂相关学科专家组成的特别工作组。
特别工作组成员提供个人经验并确定将从中寻求共识的已发表文献（MEDLINE文章、教科书、药典等）。根据研究设计和科学价值，对已发表文献进行审查并分类为四个预定类别之一。
特别工作组作为一个整体召开了几次会议，并在1年时间内通过电话会议多次以小组形式召开会议，以确定相关文献并达成供整个特别工作组讨论的共识性建议。考虑了科学信息的权重与专家观点之间的关系。在接下来的一年里，由特别工作组指导委员会撰写文件草案，并由特别工作组成员进行辩论，直到通过名义群体法达成共识。然后，ACCM董事会对特别工作组草案进行审查、评估和编辑。在指导委员会批准后，该文件草案由SCCM理事会进行审查和批准。
为便于快速传播完整且未删节的实践参数文件中包含的三项建议，ACCM董事会编写了一份执行摘要以供发表，该执行摘要得到了特别工作组指导委员会和SCCM执行理事会的批准。
专家共识提供了三项建议及支持数据，用于在危重症患者中实现持续神经肌肉阻滞：a）泮库溴铵是大多数危重症患者的首选神经肌肉阻滞剂；b）维库溴铵是患有心脏病或血流动力学不稳定且心动过速可能有害的患者的首选神经肌肉阻滞剂；c）接受神经肌肉阻滞剂的患者应适当评估所维持的阻滞程度。本执行摘要有选择地提供了支持信息，并非完整文件的替代品。
