vents and sedation? - page 2

I work at a smaller hopital in a 12 bed ICU. We frequently have patients who are unsedated on the vent. I am new to the ICU, but I thought sedating vented patients was pretty much standard of care.... Read More

  1. by   gradcare
    re:sedation,
    most people who are ventilated will be sedated initially (I've seen polypharm o.d.s and iv od's who provided their own and were tubed "dry" or flat. Simply put sedation needs to be light enough to assess the patient and begin weaning when appropriate but "heavy" enough to maintain patient comfort. I have seen only 2 general exceptions 1 head injuries with sedation used as neuro-protection and 2 burns (nuff said)
  2. by   BlueEyedRN
    We've had quite a few patients who weren't sedated for several reasons. Sometimes their BP couldn't tolerate it and we had to just try other ways to make them comfortable as possible. Sometimes, they just didn't need it and would just sit their watching TV while the vent breathed away for them. Our intensivists are all about comfort which for different people means different things and sometimes they just don't need it.
  3. by   dfk
    Quote from BlueEyedRN
    We've had quite a few patients who weren't sedated for several reasons. Sometimes their BP couldn't tolerate it and we had to just try other ways to make them comfortable as possible. Sometimes, they just didn't need it and would just sit their watching TV while the vent breathed away for them. Our intensivists are all about comfort which for different people means different things and sometimes they just don't need it.
    why not try versed/fentanyl? these rarely affect BP unless extremely large doses are used. you can get good control with adequate dosing. what may occur is bradycardia with fentanyl, but other than that, shouldn't be any issues.
  4. by   HHW2006
    We use propofol in our ICU with daily wake ups done on everyone as appropriate. Occassionally we have docs who will order sedation stopped and then we have issues with the pt becoming extremely anxious. I say keep the pt sedated until you are ready to wean - I wouldn't want to be awake with a tube in my throat!
  5. by   cardsRN
    this is a HUGE peeve of mine. pt vented with no intention of weaning to extubate, NOT tolerating the vent, going wild levitating off the bed with a fresh sternotomy and the doc's say no to sedation. it's a huge pt safety/comfort issue in my mind. this is a problem particularly on the unit i work in now.
    facility protocol is bolus sedation initially, if necessary on gtt with daily wake-ups.
  6. by   msjangir
    Hi all,
    Sedation for the ventilated pts depend on the stage of the patient. If a pt had MI and we have to intubate him than it is always better to sedate him because unsedated MI pts struggle with respirator thus increasing cardiac workload. On the other hand if we are weaning the pts its very important to keep him off sedation with sufficient time so he will be not drowsy at the time of extubation. But always we nurses should carry out sedation score assessment during the sedation. I am working in a sicu+micu, trhis is the protocol we are following.
  7. by   nursbee04
    I love propofol. Works well with most patients. It is a huge pet peeve of mine to come in and get report on a vent patient who is practically coming off the bed and when I ask what they are getting for sedation the dayshift nurse replies "Ativan 2mg Q4 hours PRN." As if that counts or something.
  8. by   ertravelrn
    This is off subject, but had a trached and vented patient that slept on his stomach.......really never could figure out how he did that
  9. by   GrnHonu99
    Quote from cardiacRN2006
    It's very rare that our vented pts aren't sedated.
    ours either. We actually have icu protocol stating if a pt is vented they should be sedated. That being said, I still have to "wake them up" every so often for a neuro assessment and if the tube isnt bothering them (which is rare) then I won't sedate them any further...ive only had one pt that indicated to me that the tube didn't bother him.
  10. by   ripcurl1
    I know this reply is a little late but...just to add to the thread....Most situations depend on the status of the patient and the team's plan. If they are planning on weaning to extubate sedation may delay that process. We place most patients on propofol and low dose fentanyl most of the time even if they are just remaining intubated overnight. We have started using a new medication called precidex which helps with the anxiety while being intubated but doesn't suppress your respiratory drive. It must be turned off though within 6 hours of extubation per our protocol.

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