The wording of individual recommendations, including strength of the recommendations and the quality of evidence upon which the recommendations were based, were agreed upon through consensus of Task Force members after discussing the relevant factors described above. Conditions requiring mechanical ventilation (e.g., acute respiratory distress syndrome [ARDS], status asthmaticus), Shivering associated with therapeutic hypothermia, Acute brain injury and elevated intracranial pressure (ICP), To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient", To incorporate new data on the basic science and clinical use of neuromuscular-blocking agents (NMBAs) in the intensive care unit (ICU), Adults who are patients in medical and surgical intensive care units (ICUs), Special populations with critical illnesses being treated with neuromuscular blocking agents (NMBAs), including patients with myasthenia gravis, obese patients, pregnant patients, and patients with suspected brain death or who are at the end of life, Use of neuromuscular blocking agents (NMBAs), including route of administration, Monitoring degree of neuromuscular blockade with peripheral nerve stimulation (PNS) (if used) and assessment of other clinical findings (e.g., triggering of the ventilator and degree of shivering), Use of a protocol that includes guidance on NMBA administration in patients undergoing therapeutic hypothermia, Use of sedative and analgesic drugs prior to initiating neuromuscular blockade, Physiotherapy for patients receiving continuous infusions of NMBA, Scheduled eye care that includes lubricating drops or gel and eyelid closure for patients receiving continuous infusions of NMBA, Measures to attenuate the risk of unplanned extubation, Targeting a blood glucose level of less than 180 mg/dL in patients receiving NMBAs, NMBA dosing considerations in special populations, 28-day, 90-day, 1-year, intensive care unit (ICU), or hospital mortality, Barotrauma (assessed with new pneumothorax, pneumomediastinum, subcutaneous emphysema, or pneumatocele), ICU-acquired weakness (assessed with Medical Research Council scale), 6-minute walk distance at hospital discharge, Adverse effects and complications of neuromuscular-blocking agents (NMBAs). This development is the result of several years of campaigning activity, including parliamentary pressure and meetings with government ministers, as well as an ongoing and constructive dialogue with NICE. The Task Force used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to rate the quality of evidence and strength of the recommendation for each clinical practice question. The Utility and Practice of Electrodiagnostic Testing in the Pediatric Population: An AANEM Consensus Statement, Endorsed by AANEM Available from the Critical Care Medicine Journal Web site. Register This field is for validation purposes and should be left unchanged. Quality Quality Access the Axon Registry®, quality measures, tools to help meet quality payment program requirements, and patient engagement handouts. Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. A guidelines app is available from the SCCM Web site. The Task Force has factored these considerations into their recommendations and have described important subgroup considerations when deemed appropriate. Caring for patients with neuromuscular disease (NMD) is challenging. XV. Relevance XXI. Dr. Nix disclosed other healthcare professional organization activities with the American College of Osteopathic Surgery committees 1 (in-service exam committee). Studies involving pediatric patients, operating room patients, or outpatients, as well as studies published prior to the year 2000 were excluded. Dr. Sands disclosed family relationships with makers of healthcare products, for-profit of healthcare services/products, and with providers of healthcare services (consultant/speaker bureau for Hospira, HillRom, and she is owner of Critical Care Learning Curves business focused on critical care continuing education) and disclosed other healthcare professional organization activities (active member of Old Salem AACN and National Member as well). Is there a preferred monitoring approach for patients with myasthenia gravis who are receiving NMBAs? The updated information was verified by the guideline developer on August 10, 2017. Recommendation: The Task Force recommends the use of a protocol that includes guidance on NMBA administration in patients undergoing therapeutic hypothermia (good practice statement). IV. End of Life Care Getting Better Living with Illness. In patients who are mechanically ventilated, does neuromuscular blockade improve the accuracy of intravascular-volume assessment (i.e., respiratory-induced variations in hemodynamic indexes)? Do patients receiving sustained NMBA infusions require special nutritional considerations? Drugs that enhance neuromuscular transmission Anticholinesterases are used as first-line treatment in ocular myasthenia gravis and as an... 2013/14 NHS STANDARD CONTRACT FOR DIAGNOSTIC SERVICE FOR RARE NEUROMUSCULAR DISORDERS (ALL AGES) PARTICULARS, SCHEDULE 2 - THE... Ankle-foot orthotic management in neuromuscular disorders: recommendations for future research. Thanks to the dedication and commitment of so many living with a neuromuscular condition, backed by the expert guidance of leading neuromuscular clinicians, we are making significant progress towards securing improvements to the provision of specialist care and support. The positive announcement from NICE will also strengthen the Muscular Dystrophy Campaign’s Department of Health-funded Bridging the Gap project to make sure that standards of neuromuscular care are met as part of the recent commitment by the NHS to deliver specialised neuromuscular services. Relevant literature was compiled from databases (MedLINE, OVID, Clinicaltrials.gov, CINAHL, Cochrane Central Database, and Medwatch), search engines (PubMed and Google Scholar), reference lists from retrieved publications, and the expertise of the authors. In critically ill patients on continuous infusions of NMBAs, do electroencephalogram-derived parameters (e.g., Bispectral Index [BIS], E-entropy, Cerebral State Index, and Patient State Index) improve sedation assessment? Readers with questions regarding guideline content are directed to contact the guideline developer. Respiratory care is of the utmost importance because it is a major determinant of quality of life and survival. Summaries for neurologists and patients are available. Recommendation: The Task Force recommends that NMBAs be discontinued prior to the clinical determination of brain death (good practice statement). Healthcare Improvement Scotland as required by the Health and Social Care Act (2012). In critically ill patients receiving NMBAs, has a specific target for blood glucose level been shown to decrease the risk of prolonged weakness? Dr. Rochwerg disclosed healthcare professional organization activities (Guideline methodologist for ATS, Canadian Blood services, American Hematology Society). Fax: 507.288.1225 While there are no treatments which directly reverse the muscle weakness, good care, support and therapies can help manage living with the condition. The Task Force used the phrasing "we recommend" for strong recommendations and "we suggest" for weak recommendations. This activity was funded by the Society for Critical Care Medicine, and no industry support was provided.