Sedation and Neuromuscular Blockade

Patients with ARDS and progressive hypoxia require mechanical ventilation. Critically ill patients may require sedation when high ventilator settings are used or when patients fight the ventilator. Mechanically ventilated patients should receive sedation by a protocol that includes a daily interruption or lightening of a sedative infusion un-

til the patient is awake. The utilization of sedation protocols decreases the duration of mechanical ventilation, length of hospitalization, and tracheostomy rates.

Paralysis usually is reserved for patients in whom sedation alone does not improve the effectiveness of mechanical ventilation. Neuromuscular blockers may lead to prolonged skeletal muscle weakness and should be avoided if possible. Patients requiring neuromuscular blockade should be monitored and intermittent boluses or continuous infusion should be utilized. Monitor depth of neuromuscular blockade with train-offour stimulation when using continuous infusion.

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