Hey all, so I'm one of the co-chairs of the safety/clin practice committee in the CT-ICU and we are in the process of implementing a "Sedation Vacation" protocol. I'm trying to gather more information on it from people who may have a protocol in place on their units.
For those who may not know what it is:
For patients who are sedated/paralyzed, a sedation vacation is a daily or shift assessment where the sedation is weaned or turned off to allow a neurovascular check and assess readiness to extubate. This applies to patients who are hemodynamically stable enough to tolerate being off sedation. If pt requires sedation during trial, sedation is restarted at 75% rate.
That's the basics of it, we are looking at initiating the sedation vacation at 0600, during our AM house officer shift change and then continuing until grand rounds are over, usually at 0800-0900. This would allow adequate time for sedation/paralyzation to wear off, and allow for neuro checks. After initiation of protocol, basic neuro check qhour... ours is leaning towards three criteria (awake, moving extremities, and following commands). If the three criteria for basic neuro aren't met, then further detailed neuro check is requires i.e. cranial nerves etc. Additionally, sedation is left off until pt is arousable, HO is notified every hour until so, then either d/ced or restarted.
Most of the other ICU's here have some sort of protocol here, however our pt's are rarely sedated longer than 24 hours. I know it's pretty much common sense to try and get an underlying neuro assessment on pt's who are on sedation ASAP, especially on prolonged sedation, however we have nothing official in place.
I'm looking at a few studies regarding this protocol, however it would be nice to see what other hospitals and units do. My specific questions:
1. Is your protocol initiated for every patient who is sedated, or just for patients who are prolonged... and what does your unit considered prolonged?
2. What is your unit's criteria for being "hemodynamically stable" enough to tolerate a sedation vacation protocol (i.e. open chest, ECMO, combative, crap hemodynamics)
3. Is your sedation vacation assessment a daily or qshift thing?
4. If you have a protocol in place, has your average LOS and length of mech ventilation improved?
Any opinions would be great! Any more information about your protocols or any new ideas would be much appreciated, thanks all!
Nov 17, '10
I can't answer all you questions but we vaca eveyone every day and if sedation is still needed, we put them back on 50% of what they were at and titrate as needed
Nov 19, '10
I wrote a really long reply that for some reason didn't take, so now I'll rewrite the short version
Be careful as to what time you start your sed vac, especially if the goal is extubation. Ours start at 6 am also. I've seen situations where by the time the docs round the patient got so anxious (from being intubated but not sedated for hours) that their weaning parameters and VS went to heck and we couldn't extubate or even had to re-sedate them prior to rounds. Of course, in the second situation the docs always want the sedation off AGAIN so they can "see for themselves"
Mar 10, '11
If your patient is on extubatable parameters...then sedation break applies to see how the patient is neuro wise.
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