So I had a patient (it was really my preceptor's responsibility, as I was following her around and helping her since I'm still orienting to the unit-day 8) who had severe septic shock. She had an ET tube and was sedated.

-Question 1: Can you correct me if i'm wrong? - From my understanding she died from MODS, and prior to coming to ICU she was intubated because she had ARDS? Organs are failing, when she came to the ER, she c/o belly pain for 1 month, wasn't eating at all (really really low albumin and protein in her labs) and in the OR they found pus all over her abdominal cavity. We had to keep putting bags of saline up every 7 minutes or so, and as I changed her bag of levophed, her BP dropped immediately (so i had to work quick). So this patient was in bad shape. So I'm assuming that she wasn't breathing right and her lungs weren't working because of the inflammatory response? I know the patho of sepsis is complicated, but am I on the right track?

-Question 2: I noticed that many vent patients are sedated, and others are not. This is my main question. Why are some sedated and others aren't?

--And another patient came in with respiratory distress (RR 60, Sat of like 62%) suffering from lung cancer (met.to brain) and anesthesiologist consulted with him saying he can be sedated with a tube down his throat so he can get oxygen into his body, or he can be sedated and "ride this thing out with much difficulty"...I'm pretty sure that's what she said.

Please let me know, thanks AN!!

Not an ICU nurse but if you have a preceptor try to build a relationship with her and ask her these questions, which are great questions by the way.

Not an ICU nurse but if you have a preceptor try to build a relationship with her and ask her these questions which are great questions by the way.[/quote']

I asked today actually. and I have built a relationship with my preceptor it was a question (a few questions) on my mind and I wanted to ask at that moment on AN. If you're not an ICU nurse, why bother answering a question under critical care nursing. Not to be rude i'm sure you're trying to make a suggestion, but it's obvious that I should ask my preceptor.If the whole point of going on AN was to tell people to ask someone else, what would be the point of AN in the first place? Waste of time, no offense.

I asked today actually. and I have built a relationship with my preceptor it was a question (a few questions) on my mind and I wanted to ask at that moment on AN. If you're not an ICU nurse, why bother answering a question under critical care nursing. Not to be rude i'm sure you're trying to make a suggestion, but it's obvious that I should ask my preceptor.If the whole point of going on AN was to tell people to ask someone else, what would be the point of AN in the first place? Waste of time, no offense.

I was going to answer your questions, until I read this ridiculously inappropriate and rude response to the previous poster.

Here is an excellent video showing you the patho of sepsis.

You are on the right track and this explains the details.

As for sedation of a vented patient, it can vary. Most of the time the patients are sedated for comfort or to increase effectiveness of mechanical ventilation. However there are some reasons not to sedate. If the pt. can't tolerate it-sedation lowers blood pressure, if you are already struggling to maintain BP then you don't want to add something that will lower it. If the patient is neurologically not responding they will often discontinue sedation so they can be sure they are able to get an accurate Neuro assessment. If they are planning to extubate a patient, they will turn down/off sedation to ensure that they can protect their airway after the tube is out. Because of Evidence-based practice, there has been a move toward less sedation. Some research says we should be walking our vented patients! Sedation can have negative side effects such as increased delirium in ICU patients so the idea is if we dont sedate them as much, risk is decreased.

I am sure there are other reasons but these are the ones I have seen the most.

I asked today actually. and I have built a relationship with my preceptor it was a question (a few questions) on my mind and I wanted to ask at that moment on AN. If you're not an ICU nurse, why bother answering a question under critical care nursing. Not to be rude i'm sure you're trying to make a suggestion, but it's obvious that I should ask my preceptor.If the whole point of going on AN was to tell people to ask someone else, what would be the point of AN in the first place? Waste of time, no offense.

I was going to answer your questions, until I read this ridiculously inappropriate and rude response to the previous poster.

amen, my sentiments, and ......never mind.....

Good questions. I hope your arrogance doesn't get you into trouble. It seems you are quite rude and maybe that RN behind your name has you thinking your big and bad, I hope you are able to hide some of your arrogance from your patients and their families. Typically nurses are compassionate. Hopefully you will grow into that. It seems you certainly have a wonderful knowledge base, and have the potential to be an excellent nurse. It's not all about how smart you are. Nursing is holistic.

I second VANurse2010 and will not answer the relatively simple questions of a rude new graduate.

ugh! why are people so rude? So annoying. Bella wanted to ask a question on AN, so let her! back out!

I AM an CCU nurse and have a strong desire to help someone learn in the critical care environment. However, when a professional nurse is dismissive to someone who they think is of no use to them, it leaves a really bad impression upon that nurse.

So I had a patient (it was really my preceptor's responsibility, as I was following her around and helping her since I'm still orienting to the unit-day 8) who had severe septic shock. She had an ET tube and was sedated.

-Question 1: Can you correct me if i'm wrong? - From my understanding she died from MODS, and prior to coming to ICU she was intubated because she had ARDS? Organs are failing, when she came to the ER, she c/o belly pain for 1 month, wasn't eating at all (really really low albumin and protein in her labs) and in the OR they found pus all over her abdominal cavity. We had to keep putting bags of saline up every 7 minutes or so, and as I changed her bag of levophed, her BP dropped immediately (so i had to work quick). So this patient was in bad shape. So I'm assuming that she wasn't breathing right and her lungs weren't working because of the inflammatory response? I know the patho of sepsis is complicated, but am I on the right track?

-Question 2: I noticed that many vent patients are sedated, and others are not. This is my main question. Why are some sedated and others aren't?

--And another patient came in with respiratory distress (RR 60, Sat of like 62%) suffering from lung cancer (met.to brain) and anesthesiologist consulted with him saying he can be sedated with a tube down his throat so he can get oxygen into his body, or he can be sedated and "ride this thing out with much difficulty"...I'm pretty sure that's what she said.

Please let me know, thanks AN!!

Question one. SIRS is a serious condition related to systemic inflammation, organ dysfunction, and organ failure. It is a subset of cytokine storm, in which there is abnormal regulation of various cytokines. SIRS is also closely related to sepsis, in which patients satisfy criteria for SIRS and have a suspected or proven infection. It causes massive vasodilitation and capillary bed "collapse" this is very useful...take a peek.....Welcome to Critical Care Medicine Tutorials

MODS: usually results from infection, injury (accident, surgery), hypoperfusion and hypermetabolism. The primary cause triggers an uncontrolled inflammatory response. Sepsis is the most common cause in operative and non-operative patients. Sepsis may result in septic shock. In the absence of infection, a sepsis-like disorder is termed systemic inflammatory response syndrome (SIRS). Both SIRS and sepsis could ultimately progress to multiple organ dysfunction syndrome. However, in one-third of the patients no primary focus can be found.^[1] Multiple organ dysfunction syndrome is well established as the final stage of a continuum: SIRS + infection = sepsis which leads to severe sepsis ending in Multiple organ dysfunction syndrome.

Question 2: some patient do well intubated and not sedated. Sedation will also have to be lightened for extubation. Some patients need to be sedated because of other medical instability ie: head bleed in a drug induced come or needing to be sedated/paralyzed for vent control.

Offering intubation to a lung cancer patient with mets to the brain is a tough one. I think a DNR needed to be discussed.