Neuromuscular blocking agents for open surgical tracheostomy in the Intensive Care Unit

Open surgical tracheostomy is one of the most frequent invasive procedures in critically ill patients. Surgical tracheostomies require anaesthesia, analgesia, but there is little information regarding paralytic agents effects among patients receiving tracheostomies. Our study aim is to evaluate whether the use of neuromuscular blocking agents (NMBA) in critically ill patients following tracheostomy is associated with increased rates of complications, increased hemodynamic instability. This is a single-center prospective study at Pauls Stradins Clinical University Hospital in the general intensive care unit. The study included 43 critical care patients who were intubated and scheduled for surgical insertion of a tracheostomy. Patients were randomised into two groups: 1. NMBA (with neuromuscular blocking agents) 2. No-NMBA (without neuromuscular blocking agents). We recorded demographic data, hemodynamic instability time (min), total consumption of analgesic, sedative agents catecholamine consumption and early complications. Out of 43 included patients, 22 received NMBAs during the procedure. Patients who did not receive NMBAs showed higher consumption of propofol (p=0.032) and Sodium Oxybutyrate (p=0.008) for sedation than patients who received NMBAs and were more likely to develop coughing (p=0.00). There were no statistically significant difference between groups in fentanyl consuption (P=0.926) and Surgeon’s assessment about procedure. Hemodynamic instability time (P=0.611), catecholamine consumption (P=0.673). Neuromuscular block reduces the risk of early complications - cough and reduces needs for sedative agents.