Persistent Paralysis in Critically Ill Patients After Long-Term Administration of Vecuronium

Segredo, Veronica; Caldwell, James E.; Matthay, Michael A.; Sharma, Mimansa; Gruenke, Larry D.; Miller, Ronald D.

doi:10.1097/00132586-199310000-00025

Cited by 62 publications

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“…Different entities can explain neurophysiologic abnormalities in critically ill patients after the use of NMBAs [30]. Prolonged neuromuscular blockade due to alterations in drug clearance and an acute motor neuropathy have been associated with muscle relaxants [31,32,33], although this relationship has been disputed recently [1]. We were very careful in the appraisal of all patients, evaluating persistent neuromuscular blockade by repetitive nerve stimulations and sensory abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients

et al. 2001

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Section: Discussionmentioning

confidence: 99%

Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients

et al. 2001

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“…So kam es v. a. bei kritisch Kranken mit Nierenversagen nach kontinuierlicher Applikation von Pancuronium bzw. Vecuronium zu prolongierten neuromuskulären Blockaden [24,112]. Interessanterweise war in diesem Patientenkollektiv die Inzidenz von CIM und CIP auffallend hoch.…”

Section: > Die Cim Tritt Häufiger Und Früher Auf Als Die Cipunclassified

Erworbene Muskelschwäche beim kritisch Kranken

et al. 2011

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Intensive care unit-acquired weakness (ICUAW) is a severe complication in critically ill patients which has been increasingly recognized over the last two decades. By definition ICUAW is caused by distinct neuromuscular disorders, namely critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). Both CIP and CIM can affect limb and respiratory muscles and thus complicate weaning from a ventilator, increase the length of stay in the intensive care unit and delay mobilization and physical rehabilitation. It is controversially discussed whether CIP and CIM are distinct entities or whether they just represent different organ manifestations with common pathomechanisms. These basic pathomechanisms, however, are complex and still not completely understood but metabolic, inflammatory and bioenergetic alterations seem to play a crucial role. In this respect several risk factors have recently been revealed: in addition to the administration of glucocorticoids and non-depolarizing muscle relaxants, sepsis and multi-organ failure per se as well as elevated levels of blood glucose and muscular immobilization have been shown to have a profound impact on the occurrence of CIP and CIM. For the diagnosis, careful physical and neurological examinations, electrophysiological testing and in rare cases nerve and muscle biopsies are recommended. Nevertheless, it appears to be difficult to clearly distinguish between CIM and CIP in a clinical setting. At present no specific therapy for these neuromuscular disorders has been established but recent data suggest that in addition to avoidance of risk factors early active mobilization of critically ill patients may be beneficial.

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“…Patienten ohne spontane Atemtätigkeit durchgeführt.Eine Muskelrelaxierung und eine kontrollierte Beatmung bei beatmeten Patienten können jedoch zu einer Reihe von Nebenwirkungen führen. Beschrieben sind eine Atrophie der Atemmuskulatur [7],eine Verschlechterung der lungenmechanischen Eigenschaften [5], ein Abfall der funktionellen Residualkapazität ("functional residual capacity", FRC) mit Verschlechterung der Oxygenierung [34], persistierende Relaxierung [49] und bleibende Hörstörungen [9]. Andererseits kann eine erhaltene spontane Atemtätig-keit während maschineller Gasbeatmung bei schwerer Lungenerkrankung das Ventilations-Perfusions-Verhältnis,das Herzzeitvolumen (HZV) und den arteriellen Blutdruck verbessern [40,41].…”

Section: Der Anaesthesist 12 · 2003 | 1159unclassified

Erhaltene spontane Atemt�tigkeit w�hrend partieller Fl�ssigkeitsbeatmung

2003

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Controlled mechanical ventilation (CMV) may contribute to impaired hemodynamics in patients with respiratory failure. It is rational to assume that hybrid modalities of mechanical ventilation have fewer hemodynamic side-effects when spontaneous respiratory activity is allowed during the application of positive airway pressure. Partial liquid ventilation (PLV) has been shown to improve gas exchange in subjects with severe alveolar lung disease. We have shown that spontaneous respiratory efforts during proportional assist ventilation (PAV) is possible in experimental animals without lung disease whose lungs are partially filled with perfluorocarbons. In another series of experiments we demonstrated that PLV improves oxygenation and lung compliance in adult rabbits with severe surfactant deficiency, and in rabbits with meconium aspiration. In animals with meconium aspiration mortality, work of breathing and the degree of lung injury, as assessed by histological analysis, were reduced. In another two series of animals with and without surfactant deficiency spontaneous breathing supported by PAV was associated with increased cardiac output, stroke volume and oxygen transport, as compared to CMV after pharmacologically induced muscle paralysis. An increased arterial and venous pH in animals with surfactant deficiency during spontaneous breathing supported by PAV suggests improved tissue perfusion. Furthermore, gas exchange was improved during spontaneous breathing supported by PAV as compared to CMV and muscle paralysis.

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Persistent Paralysis in Critically Ill Patients After Long-Term Administration of Vecuronium

Cited by 62 publications

References 0 publications

Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients

Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients

Erworbene Muskelschwäche beim kritisch Kranken

Erhaltene spontane Atemt�tigkeit w�hrend partieller Fl�ssigkeitsbeatmung

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