Neuromuscular blocking agents are widely utilized to optimize care in the critically ill patient population. Their prolonged and indiscriminate use without adequate monitoring has been associated with negative outcomes. With the advent of ICU liberation protocols aimed at early immobilization and decreased sedation to decrease morbidity and mortality, knowledge of the appropriate use and monitoring of neuromuscular blocking agents in the ICU can have significant effects on patient outcomes. To care for an increasingly challenging patient population, ICU clinicians must have a sophisticated understanding of the role of neuromuscular blocking agents in the management of critically ill adult patients.