Critical Care and Shock

A survey of neuromuscular blocking agents prescribing by medical professionals in New Zealand intensive care practice


Introduction: The optimal role of neuromuscular blocking agents (NMBA) in the management of ventilated ICU patients remains controversial. Guidelines suggest they should be reserved as rescue therapy, although more recent evidence suggests judicious NMBA use may reduce inflammation and mortality. NMBA use in New Zealand intensive care practice remains unmeasured.

Aim: To describe the current NMBA use by NZ intensive care medical practitioners.

Method: A representative from every NZ ICU was contacted to encourage ICU medical practitioners to complete an online multiple-choice survey over a period of two weeks. Low return rates were followed up with emails.


Who: 70 responses, 77% consultants, 43% intensive care specialists.

How: 68% never or hardly ever used NMBA in ICU ventilation. Of those using NMBA, 88% used it mainly or exclusively as a bolus, while none used only infusions. When using NMBA 64% used a pressure mode for ventilation, 27% used a volume mode, 27% preferred a form of SIMV. Neuromuscular monitoring was used rarely or never by 50% of respondents while 25% always used it.

Which: Practitioners most frequently used rocuronium, vecuronium and pancuronium.

For whom: NMBA use in ARDS, sepsis, post cardiac arrest, advanced gestation or morbidly obese patients were infrequent. Its use in head injury was moderate, while a high frequency of use was reported if there was a high FiO2/PEEP and the dyssynchronous mechanical ventilation occurred.

Conclusion: While the frequency of NMBA prescribing in NZ ICU is relatively low, there is considerable variation in the indications, monitoring, medication used, and end points targeted.