Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient.

The objective of this study was to update the 2002 version of “Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient.”  Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines. Annually, all members completed conflict of interest statements; no conflicts were identified. This activity was funded by the Society for Critical Care Medicine, and no industry support was provided. Using the Grading of Recommendations Assessment, Development, and Evaluation system, the Grading of Recommendations Assessment, Development, and Evaluation expert on the Task Force created profiles for the evidence related to six of the 21 questions and assigned quality-of-evidence scores to these and the additional 15 questions for which insufficient evidence was available to create a profile. Task Force members reviewed this material and all available evidence and provided recommendations, suggestions, or good practice statements for these 21 questions.

The Task Force developed a single strong recommendation: we recommend scheduled eye care that includes lubricating drops or gel and eyelid closure for patients receiving continuous infusions of neuromuscular-blocking agents. The Task Force developed a further 10 weak recommendations.

Clinical Reflective Frameworks

Many different Reflective Frameworks have been developed to support the important activity of Clinical Reflection. In this online course learn about choosing the right framework for any particular circumstance.