Critically ill patients may receive neuromuscular blocking agents (NMBAs) as adjunctive therapy in acute respiratory distress syndrome, shivering management, or for selected procedures; however, the use is less frequent than in the past. In addition, post-operative patients may experience residual blockade upon direct admission to the surgical intensive care unit (ICU). Awareness of the risks and management of NMBAs is important for ICU practitioners. Many aspects of patient management during continuous paralysis were addressed in the 2016 Society of Critical Care Medicine (SCCM) Guidelines for Sustained Neuromuscular Blockade; however, the use of a reversal agent was not included. This symposium will review the guidelines and discuss the role of NMBA reversal.