I'm new to critical care and what's confusing me is the different gtts used for sedation, mostly because all my patients are never on the same thing. So I was wondering what's the indication for each.
Examples of Different Combinations of Sedation I've had:
- Fentanyl and Versed gtt
- Fentanyl and Precedex
- Fentanyl and Propofol
- Propofol and Precedex
One case that confused me was a patient I had admitted with ARDS who was mechanically ventilated and on Versed gtt and Fentanyl gtt. Her respiratory rate was set at 28, however her breathing rate was between 30-50, and she was coughing over the vent it seemed. I gave 2mg IVP Versed x2, in addition to increasing her Versed gtt up, and then finally a dose of PRN Nimbex which appeared to work for like only 15 minutes. When I made the doctor aware, she said to switch her over to a Propofol gtt and off the Versed gtt if she could tolerate it. So again, my question is, why Propofol instead of Versed? I mean, it definitely worked after some titration, but I'm trying to understand why she was on Versed in the first place, and why Propofol was better for her?