Neuromuscular blockade in the ICU: if you can't measure it, you can't manage it

Whenever and wherever neuromuscular blocking (NMB) drugs are used, they should be administered and monitored safely. While the use of NMB drugs in anaesthesia for elective surgery is common [1], these patients are, in the main, reasonably healthy and drug pharmacokinetics are relatively predictable. While the use of NMB drugs is less prevalent in the intensive care unit (ICU), a large observational study found that >12% of patients whose lungs were mechanically ventilated received NMB drugs for at least one day [2].