Use of sedating drugs and neuromuscular blocking agents in patients requiring mechanical ventilation for respiratory failure: a national survey

Article Abstract:

Sedatives and neuromuscular blocking agents are often used to treat patients on mechanical ventilators at many hospitals that train pulmonary specialists. A survey of 164 hospitals found that all but one used sedatives and 98% used neuromuscular blockers to treat patients with respiratory failure who are on a ventilator. Thirty-six percent used sedatives routinely in more than 70% of their patients and most (48%) used them frequently. Opiates and benzodiazepines were the most commonly used sedatives. Sedatives were used to decrease anxiety and induce sleep. Only two percent of the hospitals used neuromuscular blockers routinely. Seventy percent used these drugs only occasionally, and in less than 20% of their patients. These drugs were used to reduce spontaneous breathing, muscle movement and oxygen intake. The cost of using sedatives and neuromuscular blockers can be up to $1,000 per day and they may cause side effects such as coma and paralysis.

Drug therapy, Neuromuscular blocking agents, Sedatives, Hypnotics and sedatives, Respiratory insufficiency

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The role of polyneuropathy in motor convalescence after prolonged mechanical ventilation

Article Abstract:

Electromyography (EMG) in the intensive care unit (ICU) may identify critically ill patients at risk for polyneuropathy. Polyneuropathy is a severe disease involving several nerves and is associated with mortality. Researchers studied 50 patients under the age of 75 who had received mechanical ventilation in the ICU for more than seven days. Motor polyneuropathy was diagnosed in 29 of the 50 patients, an incidence of 58%, by using EMG in the ICU. The patients with polyneuropathy had a higher rate of death in the ICU, mostly related to multiple organ failure and suspected gram-negative sepsis. Mechanical ventilation lasted longer and recovery was slower in patients with polyneuropathy because of complications. Polyneuropathy may develop as a result of prolonged mechanical ventilation.

Diagnosis, Complications and side effects, Artificial respiration, Mechanical ventilation, Critically ill, Polyneuropathies

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Immunologic aspects of neurological and neuromuscular diseases

Article Abstract:

The nervous system was once considered isolated from the immune system, but this is now known to be incorrect. Guillain-Barre syndrome is an example of an inflammatory polyneuropathy, an inflammation of the peripheral nerves. Some patients have antibodies to myelin, a component of the sheath that surrounds some nerve cells. Multiple sclerosis involves autoimmune destruction of the myelin sheath, and is characterized by several immune system abnormalities. Polymyositis and dermatomyositis may involve an autoimmune attack; muscle biopsies have revealed deposition of antibodies in blood vessel walls. Most patients with myasthenia gravis - a disease characterized by muscle weakness - have antibodies against the acetylcholine receptor at the neuromuscular junction.

Physiological aspects, Guillain-Barre syndrome, Multiple sclerosis, Polymyositis, Dermatomyositis, Myasthenia gravis

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