{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:32:41Z","timestamp":1790652761293,"version":"4.1.0"},"reference-count":60,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2011,8,9]],"date-time":"2011-08-09T00:00:00Z","timestamp":1312848000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2011,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To summarize literature describing use of neuromuscular blocking agents (NMBAs) for common critical care indications and provide a review of NMBA pharmacology, pharmacokinetics, dosing, drug interactions, monitoring, complications, and reversal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources:<\/jats:title>\n                    <jats:p>Searches of MEDLINE (1975-May 2011). EMBASE (1960-May 2011), and Cumulative Index to Nursing and Allied Health Literature (1981-May 2011) were conducted to identify observational and interventional studies evaluating the efficacy or safety of NMBAs for management of acute lung injury (ALI)\/acute respiratory distress syndrome (ARDS), status asthmaticus, elevated intracranial pressure (ICP), and therapeutic hypothermia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Selection And Data Extraction:<\/jats:title>\n                    <jats:p>We excluded case reports, animal- or laboratory-based studies, trials describing NMBA use during rapid sequence intubation or in the operating room, and studies published in languages other than English or French.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Synthesis:<\/jats:title>\n                    <jats:p>Clinical applications of NMBAs in intensive care include, but are not limited to, immobilizing patients for procedural interventions, decreasing oxygen consumption, facilitating mechanical ventilation, reducing intracranial pressure, preventing shivering, and management of tetanus. Recent data on ARDS demonstrated that early application of NMBAs improved adjusted 90-day survival for patients with severe lung injury. These results may lead to increased use of these drugs. While emerging data support the use of cisatracurium in select patients with ALI\/ARDS, current literature does not support the use of one NMBA over another for other critical care indications. Cisatracurium may be kinetically preferred for patients with organ dysfunction. Close monitoring with peripheral nerve stimulation is recommended with sustained use of NMBAs to avoid drug accumulation and minimize the risk for adverse drug events. Reversal of paralysis is achieved by discontinuing therapy or, rarely, the use of anticholinesterases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>NMBAS are high-alert medications used to manage critically ill patients. New data are available regarding the use of these agents for treatment of ALI\/ARDS and status asthmaticus, management of elevated ICP, and provision of therapeutic hypothermia after cardiac arrest. To improve outcomes and promote patient safety, intensive care unit team members should have a thorough knowledge of this class of medications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1345\/aph.1q004","type":"journal-article","created":{"date-parts":[[2011,8,10]],"date-time":"2011-08-10T00:33:03Z","timestamp":1312936383000},"page":"1116-1126","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":51,"title":["Current Therapeutic Uses, Pharmacology, and Clinical Considerations of Neuromuscular Blocking Agents for Critically III Adults"],"prefix":"10.1177","volume":"45","author":[{"given":"Julia","family":"Warr","sequence":"first","affiliation":[{"name":"University of Waterloo, Waterloo, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zo\u00e9","family":"Thiboutot","sequence":"additional","affiliation":[{"name":"Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Rose","sequence":"additional","affiliation":[{"name":"Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario; Mount Sinai Hospital, Toronto; Adjunct Scientist, Li Ka Shing Institute, St Michael's Hospital, Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangeeta","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital; University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa D","family":"Burry","sequence":"additional","affiliation":[{"name":"Department of Pharmacy; Department of Medicine, Mount Sinai Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2011,8,9]]},"reference":[{"key":"bibr1-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1378\/chest.128.2.496"},{"key":"bibr2-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200201000-00021"},{"key":"bibr3-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000145907.86298.12"},{"key":"bibr4-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa012689"},{"key":"bibr5-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa003289"},{"key":"bibr6-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-2416"},{"key":"bibr7-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200005043421801"},{"key":"bibr8-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0B013E3181653895"},{"key":"bibr9-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1001\/jama.299.6.637"},{"key":"bibr10-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1001\/jama.299.6.646"},{"key":"bibr11-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000156794.96880.DF"},{"key":"bibr12-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1016\/S0012-3692(15)31165-X"},{"key":"bibr13-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1614"},{"key":"bibr14-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1496"},{"key":"bibr15-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1005372"},{"key":"bibr16-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-198404000-00018"},{"key":"bibr17-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1007\/BF01700963"},{"key":"bibr18-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-002-1508-y"},{"key":"bibr19-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000104114.72614.BC"},{"key":"bibr20-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000239435.87433.0D"},{"key":"bibr21-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.153.5.8630621"},{"key":"bibr22-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1378\/chest.115.6.1627"},{"key":"bibr23-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-001-1112-6"},{"key":"bibr24-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-008-1267-5"},{"key":"bibr25-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199409000-00019"},{"key":"bibr26-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.1997.tb04651.x"},{"key":"bibr27-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199707000-00028"},{"key":"bibr28-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-199801000-00025"},{"key":"bibr29-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc1998.7.3.205"},{"key":"bibr30-aph.1Q004","first-page":"467","volume":"76","author":"Juul N","year":"2000","journal-title":"Acta Neurochir Suppl"},{"key":"bibr31-aph.1Q004","first-page":"217","volume-title":"Goodman & Gilman's the pharmacological basis of therapeutics","author":"Brunton LL","year":"2007","edition":"11"},{"key":"bibr32-aph.1Q004","first-page":"224","volume-title":"Irwin and Rippe's intensive care medicine","author":"Irwin R","year":"2008","edition":"6"},{"key":"bibr33-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/58.24.2381"},{"key":"bibr34-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181d5ae47"},{"key":"bibr35-aph.1Q004","first-page":"136","volume-title":"Goodman and Gilman's manual of pharmacology and therapeutics","author":"Brunton LL","year":"2007","edition":"11"},{"key":"bibr36-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199409000-00010"},{"key":"bibr37-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0b013e3283220e60"},{"key":"bibr38-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.2165\/11319930-000000000-00000"},{"key":"bibr39-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2008.02.003"},{"issue":"1","key":"bibr40-aph.1Q004","first-page":"S71","volume":"24","author":"Brain Trauma Foundation, American Association of Neurological Surgeons (AANS), Congress of Neurological Surgeons (CNS), AANS\/CNS Joint Section on Neurotrauma and Critical Care.","year":"2007","journal-title":"J Neurotrauma"},{"key":"bibr41-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/01376517-199504000-00007"},{"key":"bibr42-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000079019.02601.90"},{"key":"bibr43-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0b013e3282f51d6d"},{"key":"bibr44-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2008.09.017"},{"key":"bibr45-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181d8cacf"},{"key":"bibr46-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000281517.97507.6E"},{"key":"bibr47-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1592\/phco.28.1.102"},{"key":"bibr48-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.2165\/11319360-000000000-00000"},{"key":"bibr49-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200605000-00025"},{"key":"bibr50-aph.1Q004","first-page":"1231","volume-title":"Drug interaction facts","author":"Tatro DS","year":"2010"},{"key":"bibr51-aph.1Q004","first-page":"34","volume":"2","author":"Prielipp RC","year":"1994","journal-title":"New Horiz"},{"key":"bibr52-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpem.2009.03.004"},{"key":"bibr53-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/00003465-200307000-00001"},{"key":"bibr54-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199704000-00005"},{"key":"bibr55-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.156.5.9701079"},{"key":"bibr56-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.4.1267"},{"key":"bibr57-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2005.07.002"},{"key":"bibr58-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181cc4b53"},{"key":"bibr59-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aep093"},{"key":"bibr60-aph.1Q004","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2008.08.003"}],"container-title":["Annals of Pharmacotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1345\/aph.1Q004","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1345\/aph.1Q004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:08:55Z","timestamp":1777374535000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1345\/aph.1Q004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,8,9]]},"references-count":60,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2011,9]]}},"alternative-id":["10.1345\/aph.1Q004"],"URL":"https:\/\/doi.org\/10.1345\/aph.1q004","relation":{},"ISSN":["1060-0280","1542-6270"],"issn-type":[{"value":"1060-0280","type":"print"},{"value":"1542-6270","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,8,9]]}}}