Sedation in ICU... your opinions/ experiences? - page 5

Just wondering, how many of your vented pts are sedated, and with what? Are there certain pts that you always do or do not sedate, or is it always a case by case basis. Most nurses on my unit would agree that we do NOT sedate... Read More

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    Quote from expatRNdk
    . Neuro patients are sedated obviously, but we don't have those, they are at our NICU .
    I find it strange that you are sedating a Neuro patient, how are you then getting an accurate neuro check out of them, especially if they had deficits before the sedation?? Our neurosurgeons RARELY order sedation for their preop or postop patients, and if by some chance they do order sedation, its is usually a very small dose of propofol. They discourage the use of prn ativan unless it is very much needed, like hx of etoh. We even had a neurosurgeon refuse to order a 1x dose of iv benedryl for a patient with a small SDH, even though the were a&o x3.

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  2. 1
    Quote from traumasurgRN
    I find it strange that you are sedating a Neuro patient, how are you then getting an accurate neuro check out of them, especially if they had deficits before the sedation?? Our neurosurgeons RARELY order sedation for their preop or postop patients, and if by some chance they do order sedation, its is usually a very small dose of propofol. They discourage the use of prn ativan unless it is very much needed, like hx of etoh. We even had a neurosurgeon refuse to order a 1x dose of iv benedryl for a patient with a small SDH, even though the were a&o x3.
    I can attest to this as a neuro ICU patient! No matter that I'd just had my head carved into, bits and pieces removed, screwed & stapled back together. I still needed to know what the date was, who I was and where I was q 1 hour starting the moment I woke from surgery! I was allowed fentanyl PRN's but soon found those caused me to vomit so we (I) stopped them. Now I wasn't intubated post op...that I can remember, but it has been my experience (also as a pedi/neonatal ICU nurse) that neuro patients really get the shaft when it comes to sedation
    Sugarcoma likes this.
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    We've tried using Precedex when we're short on propofol, but the docotors don't realize that Precedex is an adjunct to propofol/other sedation methods, it cannot just be started on its own. The drug company specifically draws out the appropriate way to add Precedex for sedation and wean off propofol, but I have yet to see it ordered that way. I've also had issues with using midazolam drips it seems you still need to add additional fentanyl to better comfort the patient.
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    We use a lot of versed and fentanyl gtts. A little bit of precedex. Propofol is pretty common in a newly intubated pt but we only keep them on it for 3-4 days at the most because of propofol syndrome.
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    Our facility is fond of using Ativan drips, which I personally hate because of increased binding to fat tissue and people on Ativan drips are very difficult to ween off as opposed to Propofol (which we never use anymore). I also see Fentanyl and Ativan or fentany and versed used quite often in my facility.
    Last edit by mybanez on Dec 7, '12
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    I work in a children's ICU but we stock standard start most intubated patients on morph + midaz infusions and work from there. Neuro kids typically come off these quickly to assess their GCS etc. If the child has pain issues rather than sedation issues we'll often switch midaz for ketamine to control their pain. If sedation is an issue we'll either switch midaz for Precedex or just add it. We keep Profopol in our resus drug dish on the end of the bed, and, if the child is lively (and has enough IV access) with keep the syringe on a three way tap just in case. If the child is requiring a large amount of Profopol pushes (and is maxed out on sedation) we will then add an infusion (this happens only occasionally.) We also use Clonidine, Diazepam (instead of a midaz infusion) and Vallergen down an NG if the patient is not NBM and is tolerating some feeds.
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    Fentanyl is used the most. We are teaching hospital, and they don't like propofol, plus there is a nation wide shortage. Precedex is rarely used.
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    We have hit or miss sedation. Some of our doctors are very good about sedating usually with either propofol or Versed. Some are kind enough to order a sedation/analgesia combo. Some only order sedation with no analgesia and I find that to be very cruel.

    As for neuro patients, we had a wonderful neuro-intensivist who would order propofol for these patients. We would simply turn the drip off for a little while to do neuro checks. His reasoning for ordering sedation was to reduce ICP spikes. We did travel to CT more frequently with his patient's but overall they were much more comfortable than other doctors patients were. He was a very kind man and it was important to him his patients were comfortable and well-ventilated. He has left our facility and our current neuro doc does not believe in sedation/analgesia at all.

    Probably the worst shift I have ever had was spent with an elderly gentlemen who had broken his neck/part of his spine leaving him paralyzed. His family had a POA that stated if paralyzed/vegetative state he DID not want intubation etc but we didn't know that when he was brought in. In the end he ended up on a vent with the family, docs, and the patient agreeing he would be terminally weaned in the morning. That poor man tried his level best to chew through his ET tube and bucked the vent all night long. He was so obviously miserable. The doctors refused to sedate him. Their reasoning was it would interfere with his neuro checks!! I begged and pleaded all night long up to and including the attending but no luck. He received no sedation until it was time to extubate. So cruel.
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    Quote from Sugarcoma
    As for neuro patients, we had a wonderful neuro-intensivist who would order propofol for these patients. We would simply turn the drip off for a little while to do neuro checks. His reasoning for ordering sedation was to reduce ICP spikes.
    As a student I did a placement in one of the countries biggest/most respected neuro ICUs where this was the norm. It seemed to do a good job. Comfortable however assessable patients.
    Sugarcoma likes this.


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