A new UK-wide service evaluation will shed light on how continuous neuromuscular blockade is used in intensive care units.
The first comprehensive evaluation of its kind will assess how these high-risk muscle relaxant infusions are prescribed, maintained, monitored, and discontinued in critically ill adult and paediatric patients, as well as how often they’re used and the patient groups in which they are used.
It’s being led by Dr Richard O’Sullivan, intensive care trainee and clinical research fellow at The University of Manchester in conjunction with Salford Royal’s critical care at Northern Care Alliance NHS Foundation Trust.
The service evaluation, TRIC-BLOCK, is being delivered by the TRIC (Trainee Research in Intensive Care) Network in partnership with the Paediatric Critical Care Society Trainee’s Audit & Research network (PICSTAR), and is supported by the Intensive Care Society and the Faculty of Intensive Care Medicine.
Better guidelines
More than 100 hospitals around the UK will contribute to the work, including 20 paediatric intensive care units.
Continuous infusions of neuromuscular blocking drugs are used in some of the sickest patients on ventilators, notably those who have severe respiratory failure and traumatic brain injury. But there is a risk of complications, including long standing muscle weakness and the potential for the drugs not clearing as quickly as they should when they have been stopped.
Dr O’Sullivan explained: “There’s been a lack of research into continuous neuromuscular blockade and there’s a need for better guidelines. It’s an important part of intensive care but we don’t really know how prevalent its use is. Most of the guidance we have is based on using the drug cisatracurium but that was in short supply during the pandemic so many ICUs used rocuronium as an alternative and have continued to do so. However, there is no research on its effectiveness or the best way to administer it.
“This service evaluation will give us a snapshot of current prevalence and practice by collecting data from patients who are on invasive mechanical ventilation during the study period in March.
“The information we gather will be published and could inform future research as well as being the first step in consulting experts for future guidelines.
“It’s really exciting to be collaborating with our paediatric colleagues on this project.”