| Title: |
Neuromuscular Blockade for Intracranial Hypertension: Quantifying Real-World Effectiveness on Intracranial Pressure |
| Authors: |
Goder, Noam; Rubenfeld, Gordon D.; Amaral, Andre C.K.B. |
| Source: |
Journal of Intensive Care Medicine ; ISSN 0885-0666 1525-1489 |
| Publisher Information: |
SAGE Publications |
| Publication Year: |
2026 |
| Description: |
Background Contemporary intracranial hypertension guidelines, including SIBICC (2019) and the 2024 ACS Best Practices, list neuromuscular blockade as a Tier Two, short-duration option for refractory ICP elevation. Despite its physiologic rationale, the real-world effect of initiating continuous paralysis on ICP has not been quantified using large-scale intra-patient physiologic data. Methods We performed a retrospective intra-patient before–after study at a Level 1 trauma and neurocritical care center (2016-2021). Among 9373 ICU admissions, 106 patients receiving a Rocuronium infusion with continuous invasive ICP monitoring met inclusion criteria. ICP values were compared using symmetric pre/post windows (−165-0 min; +15-180 min). A generalized additive model (GAM) evaluated time-dependent ICP changes adjusting for sedatives and hypertonic saline. Results Median ICP decreased from 20.7 to 18.6 mm Hg (within-patient Δ −0.9 mm Hg; P = .017). Cerebral perfusion pressure increased from 71.1 ± 10.5 to 75.2 ± 12.5 mm Hg ( P < .001). In patients with pre-treatment ICP > 20 mm Hg, median ΔICP was −2.0 mm Hg ( P < .001). Adjusted GAM modeling demonstrated reductions of −1.66 mm Hg at 3 h and −2.23 mm Hg at 6 h. Conclusions Continuous Rocuronium infusion was associated with modest (approximately 1-2 mm Hg) reductions in ICP and improved CPP. Although these physiologic changes are small and may have limited clinical significance, this study provides the largest real-world evaluation and quantification of the effect of continuous neuromuscular blockade on ICP control and directly informs a major evidence gap highlighted in contemporary guidelines. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1177/08850666261432119 |
| Availability: |
https://doi.org/10.1177/08850666261432119; https://journals.sagepub.com/doi/pdf/10.1177/08850666261432119; https://journals.sagepub.com/doi/full-xml/10.1177/08850666261432119 |
| Rights: |
https://creativecommons.org/licenses/by/4.0/ ; https://journals.sagepub.com/page/policies/text-and-data-mining-license |
| Accession Number: |
edsbas.1A0E6412 |
| Database: |
BASE |