Residual neuromuscular blockade is associated with significant morbidity. It has been widely studied in anaesthesia; however, the incidence of residual neuromuscular blockade in patients managed in the ICU is unknown. We conducted a prospective observational study in a tertiary ICU to determine the incidence of residual neuromuscular blockade using quantitative accelerographic monitoring. We tested for residual neuromuscular blockade (defined as a train-of-four ratio < 0.9) before cessation of sedation in anticipation of tracheal extubation. We also surveyed 16 other ICUs in New Zealand to determine their use of neuromuscular monitoring. A total of 191 patients were included in the final analysis. The incidence (95%CI) of residual neuromuscular blockade was 43% (36–50%), with a similar incidence observed in non-postoperative and postoperative patients. There was a lower risk of residual neuromuscular blockade with atracurium than rocuronium (risk ratio (95%CI) of 0.39 (0.12–0.78)) and a higher risk with pancuronium than rocuronium (1.59 (1.06–2.49)). Our survey shows that, in New Zealand ICUs, monitoring of neuromuscular function is rarely carried out before tracheal extubation. When neuromuscular monitoring is undertaken, it is based on individual clinician suspicion and performed using qualitative measurements. No ICU reported using a quantitative monitor or a clinical guideline. The results demonstrate a high incidence of residual neuromuscular blockade in our ICU patients and identify the type of neuromuscular blocking drug as a possible risk factor. Monitoring neuromuscular function before tracheal extubation is not currently the standard of care in New Zealand ICUs. These data suggest that residual neuromuscular blockade may be an under-recognised problem in ICU practice.

中文翻译：

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ICU中残留的神经肌肉阻滞：一项前瞻性观察研究和全国调查

残留的神经肌肉阻滞与显着的发病率有关。它在麻醉中得到了广泛的研究；然而，在 ICU 管理的患者中残留神经肌肉阻滞的发生率尚不清楚。我们在三级 ICU 进行了一项前瞻性观察研究，以使用定量加速度监测来确定残余神经肌肉阻滞的发生率。我们在因预期气管拔管而停止镇静之前测试了残余神经肌肉阻滞（定义为四组比率 < 0.9）。我们还调查了新西兰的其他 16 个 ICU，以确定他们使用神经肌肉监测的情况。最终分析共纳入 191 名患者。残余神经肌肉阻滞的发生率 (95%CI) 为 43% (36–50%)，在非术后和术后患者中观察到相似的发生率。阿曲库铵的残余神经肌肉阻滞风险低于罗库溴铵（风险比（95%CI）为0.39（0.12-0.78）），而泮库溴铵的风险高于罗库溴铵（1.59（1.06-2.49））。我们的调查显示，在新西兰 ICU，很少在气管拔管前进行神经肌肉功能监测。当进行神经肌肉监测时，它基于个体临床医生的怀疑并使用定性测量进行。没有 ICU 报告使用定量监测器或临床指南。结果表明，我们的 ICU 患者中残留神经肌肉阻滞的发生率很高，并将神经肌肉阻滞药物的类型确定为可能的危险因素。气管拔管前监测神经肌肉功能目前不是新西兰 ICU 的护理标准。这些数据表明，残余神经肌肉阻滞剂可能是 ICU 实践中一个未被充分认识的问题。