Monitoring the depth of neuromuscular blockade in the intensive care unit
Neuromuscular blockade monitoring in the ICU
DOI:
https://doi.org/10.54205/ccc.v34.280649Keywords:
Neuromuscular blocking agents, Neuromuscular monitoring, Train-of-Four stimulation, Critical care, Intensive care unitsAbstract
Neuromuscular blocking agents (NMBAs) are widely used in the intensive care unit (ICU) to facilitate mechanical ventilation; however, excessive or prolonged blockade increases the risk of complications such as ICU-acquired weakness. Quantitative train-of-four (TOF) monitoring remains the standard for assessing depth of neuromuscular blockade, although it is often underutilized in ICU practice. Indirect methods including capnography, ventilator waveform analysis, and respiratory effort indices provide complementary but nonspecific information. Integration of quantitative and physiologic monitoring supports safer and more individualized NMBAs management in critically ill patients. This review summarizes current neuromuscular monitoring strategies in the ICU and discusses the clinical utility, limitations, and practical integration of quantitative and indirect monitoring modalities during NMBAs administration.
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