10. Monitoring degree of blockade: Suggest against the use of PNS with train of four (TOF) alone for monitoring the depth of neuromuscular blockade in patients on continuous infusion of NMBAs (weak recommendation, very low quality of evidence). Suggest PNS with TOF monitoring may be beneficial if used patient clinical assessment (weak recommendation, very low quality of evidence)
11. Physiotherapy: Suggest that in patients receiving continuous NMBA infusion receive structured regimen of physiotherapy to improve mortality, quality of life, and exercise capacity (weak recommendation, very low quality of evidence)
12 . Eye lubrication: Recommend scheduled eye care that includes drops or gel and eyelid closure for patients receiving continuous NMBA infusion (strong recommendation, low quality of evidence)
13. Nutrition: No recommendation regarding nutritional requirements specific to patients receiving infusions of NMBAs (insufficient evidence)
14. Safeguards: Recommend implementing measures (physical restraints, staffing ratios, etc.) to attenuate risk of unplanned extubation (good practice statement)
15. Blood glucose target: Suggest in critically ill patients receiving NMBAs, clinicians target a blood glucose level of less than 180 mg/dL (weak recommendation, low quality of evidence)
16. Myasthenic syndromes: Recommend a reduced NMBA dose be used in patients with myasthenia gravis and dose should be based on PNS with TOF monitoring (good practice statement)
17. Myasthenia gravis muscle group to use for monitoring: No recommendation on which muscle group to use for monitoring in patients with myasthenia gravis receiving NMBAs (insufficient evidence)
18. Obese patients: Suggest clinicians NOT use actual body weight and instead use ideal or adjusted body weight when calculating NMBA doses for obese patients (body mass index greater than or equal 30 mg/m2)
19. Pregnant patients: No recommendation on the use of NMBAs in pregnant patients (insufficient evidence)
20. Brain death: Recommend NMBAs be discontinued prior to brain death determination (good practice statement)
21. End of life: Suggest NMBAs be discontinued at end of life or when support is withdrawn (weak recommendation, very low quality of evidence)
Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient. Crit Care Med. 2016;44(11):2079-2103
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