Sedation Protocols for Intubated Patients

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Specializes in Leadership/Critical Care/Surgery/Seniors.

I am curious as to whether there are any ICU's who have a protocol in place for sedation of their intubated patients. At present, physicians write orders on an individual basis for each patient. Some discussion has arisen about the possibility of developing "standing orders" for nurses to sedate at their discression (within the parameters of the guidelines, of course). I have some concerns and reservations about implementing a protocol such as this.

Any comments??

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We implemented a sedation protocol in our unit and it has been extremely effective. The md or acnp decide what level of the sedation protocol the pt. needs and from there the nurses decide wether the pt needs just prns or gtts. Every morning we do sedation holidays and wake the pt up. When and if we need to restart the gtts, we start them at half the previous rate. We have been successful in decreasing the number of days vented and days spent in icu days. I love it and can tell you that not one of our pts have self extubated on the sedation holiday. The bedside nurses feel that they have better control of the pts sedation. The only time that pts don't qualify for sedation protocol is if they are paralysed or on a heavy mode of ventilation i.e. pcv, aprv or on ards net protocol.

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We implemented a sedation protocol in our unit and it has been extremely effective. The md or acnp decide what level of the sedation protocol the pt. needs and from there the nurses decide wether the pt needs just prns or gtts. Every morning we do sedation holidays and wake the pt up. When and if we need to restart the gtts, we start them at half the previous rate. We have been successful in decreasing the number of days vented and days spent in icu days. I love it and can tell you that not one of our pts have self extubated on the sedation holiday. The bedside nurses feel that they have better control of the pts sedation. The only time that pts don't qualify for sedation protocol is if they are paralysed or on a heavy mode of ventilation i.e. pcv, aprv or on ards net protocol.

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Specializes in ICU, CCU & PCCU/TELEMETRY.

That sounds great!! I've never worked in a place that had any kind of sedation protocol. I especially like the nurses being able to decide on prn or infusion. I am interested in hearing more about it, or being pointed to articles that discuss it.

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It does sound great!

We still discuss it with the physician for each individual patient.

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I like our doctors versed titirate to effect order, or propofol titrate to effect

otherwise it's just fentanyl 50mcg/hr

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Ativan titrated for a BIS 40-60 or Modified Ramsey 3-4--this was used with a trached patient on titrated zemuron for TOF 1-2/4

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My hospital has a standard sedation protocol sheet that the physicians simply sign and check all boxes that they want for their patients.

It's literally a menu of fentanyl, versed, ativan, propofol, etc.

The docs love it because the orders give the RN's a lot of room for judgement and flexibility with wide parameters. It saves a lot MD paging when sedation isn't effective because the docs wrote such rigid and tight sedation orders that aren't working.

Prior to this, if I had one more gunshy doc write wimpy orders like ativan 0.5-1mg IV q2h for a patient bucking the vent, freaking out, and trying to extubate themselves I don't know what I was going to do.

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We usually have an order for a Ramsey scale if patient is on continous sedation, and can titrate to effect. I think we are lucky though because we have 2 intensivists who are on call around the clock and don't hesitate to give us what we need for sedation.

I like what some of you guys have that you can choose to do prns or a continous infusion. I don't think that would be a good idea at my hospital though. We have some nurses who tend to dope the patients up, even if the patient does not require that level of sedation. I wouldn't be comfortable with some of these nurses having such a wide range of sedation to choose from. Do those of you that use have this type of problem?

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I have worked in hospitals with and without sedation protocols - I prefer the protocol vs. not having one. This gives those of us who are at the bedside with the patient and know how they are coping or not coping in some cases with being intubated the opportunity to make them comfortable.

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I don't think that would be a good idea at my hospital though. We have some nurses who tend to dope the patients up, even if the patient does not require that level of sedation. I wouldn't be comfortable with some of these nurses having such a wide range of sedation to choose from. Do those of you that use have this type of problem?

If anything, my hospital has nurses who have the direct opposite problem than at your hospital.

"Oh they don't need that,they're doing just fine."

Some don't want to restrain or sedate their patients due to the work and documentation involved.

Before you know it, they're yelling for help because their patients are halfway out of the bed with every tube they once had pulled out.

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Specializes in MICU.

Our facility uses a vent bundle on any vented patient regardless of what pulmonary guys are on the case. It includes a sedation set that includes intermittent Ativan and Morphine(fairly liberal amounts) or Propofol and Ativan drips that are titrated to desired effects. The doctors just check what they want us to use. When we use neuromuscular blockers we use another protocol separately.

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