Sedation Minimalization....Opinions Needed

heartICU · Mar 31, 2005

Okay, maybe I'm an old fuddy-duddy, but I have a problem with this. I started working in a large ICU that is much more progressive with things that where I was before (at least that was my first impression). They have been doing this sedation minimization protocol (which, BTW, I have not been able to get my hands on yet, I just started there) and try to wean off Diprovan ASAP and replace it with Ativan and Fentanyl drips. But they also will put people on Seroquel and/or Zyprexa if they have a tube and can tolerate meds down them also.
I guess I have a big problem and am very uneasy about giving people drugs like antipsychotics to critically ill people who are agitated probably because they are just so ill, not that they are psychotic from a mental health standpoint. I realize that medications can be given other than their original intended purpose, however, I believe these are pretty powerful drugs and I don't think they should be fooling with someone's mind in this kind of state. That being said, I may be dead wrong and not up with current research on these things, and perhaps the drugs are not as potent as I believe they are. Does anyone else out there give out these kinds of meds in this kind of scenario? What are you thoughts?
Like I said, I could be not with the times on these things, but I am just very leary of passing out this stuff under these circumstances.

My ICU would give Zyprexa to patients who were chronically agitated, along with haldol. Haldol was passed out like water. Sometimes it worked, sometimes it didn't/ It seemed as if you had to get on a schedule to get the haldol to work....ex: 5mg Haldol IV q4 hours...after about three doses it seemed to calm things down a bit. The Zyprexa we would usually give to lung patients...s/p lung transplant. Those patients are almost ALWAYS agitated...the Zyprexa did seem to help, but we also used it in combination with ativan and occasionally valium. Seemed like the addition of IV valium was the thing that really worked, but these are just personal observations.

PJMommy · Apr 1, 2005

Are these pt's vented? All of the vented patients get sedation...although there has recently been a push to not use as much Diprivan and instead use more Versed. Once extubated, none have sedation but many of our patients receive Seroquel as the drug of choice. It seems to really help with that ICU psychosis they develop. I've only seen Ativan drips used for ETOH withdrawal. I will get the occasional Ativan or Versed prn order for agitation. Haldol is rare -- only with the patients where nothing else works.