sedation

Specialties MICU

Published

What is your ICU sedation med of choice? Our Critical Care Surgery team is turning to precede almost exclusively and it makes me cringe! It works on some patients but others it doesn't work on and is never going to work on!!

one of the residents was telling me that all level 1 trauma hospitals are basically exclusively using preceded for sedation now.

Specializes in ICU.

The docs (residents!!) in my facility are fond of using fentanyl drips - without anything else. This drives most of us nuts! A patient will come from the ER on propofol and as soon as the docs round- you can bet that'll be the first thing they change! Then they'll order it be turned off by 0300 for SBT in the morning... And won't want anything else given to the patient. And they wonder why the patients fail the trial!

This is an interesting discussion. Propofol is great and I love it when I get a patient on it. Unfortunately, it's not used very often on my unit because we have so many sepsis patients for whom pancreatitis is in the differential. We also have a ton of liver bombs. Usually they use Fentanyl and midazolam, but it's not uncommon to see patient's obtunded on Fentanyl only.

I'm in a level I Trauma medical/cardiac ICU and I see a lot of everything. I probably see equal amounts of precedex, propofol, and versed/fent.

I don't see one more than the other.

Specializes in SICU, trauma, neuro.

Don't you wish you could tube the docs with no sedation and see how it works for them? :whistling:

The docs (residents!!) in my facility are fond of using fentanyl drips - without anything else. This drives most of us nuts! A patient will come from the ER on propofol and as soon as the docs round- you can bet that'll be the first thing they change! Then they'll order it be turned off by 0300 for SBT in the morning... And won't want anything else given to the patient. And they wonder why the patients fail the trial!
Specializes in ICU.
Don't you wish you could tube the docs with no sedation and see how it works for them? :whistling:

Why yes. Yes, I do! :)

I work SICU and we use propofol primarily post-op until they are extubated. We only use Precedex when they are extubated and need to sleep, or if they are withdrawing. Occasionally for the unsedatable patients, we use both and that seems to work. Personally, I love Propofol...it works faster and is easier to manage. Precedex always seems to tank BP and HR and does not always keep patients comfortable.

Specializes in MICU, SICU, CICU.

Precedex is an anxiolytic not a sedative.

My experience is that it works beautifully with intubated patients about 50% of the time.

It is not at all effective in DTs pts.

I have seen some dangerous pauses in afib patients on doses higher than 0.5 mcg.

Specializes in ICU.

Hospitals & critical care educators are trying to move away from propofol and the heavier sedatives because "research shows" patients undergo withdrawal from it upon extubation. Of course these are the same who will tell you an intubated patient doesn't need to be restrained if their RASS is a -2 and the next step in nursing is to ambulate your intubated patients. All sounds good in theory, but...

In our level 1, we mainly use propofol and fentanyl in conjunction for sedation. The reason we would take someone off of propofol would be because 1. their BP couldn't tolerate it, or 2. their triglyceride levels are rising. In that case, we may switch them over to precedex. The thing with dex is that it takes time to build up in the patient's system, so you have to bolus following protocol at the beginning of the treatment or else you're going to keep going up and up on the dosage thinking it's not working until they're zonked and bradycardic.

Specializes in I/DD.

It is absolutely a hit-or-miss drug. I think it is worth a shot as long as your docs leave you something to use if it isn't effective. I have mostly found it useful for patients that have had long ICU stays and are difficult to wean due to sedation issues and delirium, or people who are just about ready to extubate. Combining it with ATC haldol (barring a long qtc or an intolerance to it of course) has worked pretty well for a couple patients. One thing I do know is I hate versed long term, mostly in older patients. I literally have seen the lightbulb go off in some of these folks after a few days on it, and it is tough to get them back. Propofol/fentanyl is my favorite drug combo, or fentanyl with intermittent sedation.

Specializes in CCRN.

We use propofol and precedex. Propofol about 75% of the time precedex about 25%

Rarely will our mds order versed or fentanyl gtt

Specializes in Cardiac.

Mostly fentanyl....

And precedex sucks.

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