Neuromuscular Blockade at the End of Life

To the Editor: The complex ethical and emotional aspects of withdrawing ventilatory support from critically ill patients were well presented by Truog et al. (Feb. 17 issue) 1 in their Sounding Board article on the role of neuromuscular blockade in this difficult situation. We strongly agree that neuromuscular blocking agents must never be used in the absence of adequate sedation and analgesia. Unfortunately, this goal is not consistently attained in practice, since as many as one third of patients who receive these medications recall the experience. 2 Truog et al. appropriately differentiate between actual patient comfort and the appearance of patient comfort . . .