Hourly doses of vent sedation, is this common?

Specialties MICU

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This small ICU doc uses, (almost exclusively) 1mg to 4mg iv doses prn of ativan and morphine for vent sedation. No drips are used. Do any other ICU's do this? Are there any advantages to this? Septic patients with "iffy" blood pressures don't seem to like the morphine too well.

Specializes in ICU.

One kind of old school doc did it, when the patients were rather calm and expected to be weaned soon.

Most used diprivan, the short halflife is great, but I think there is too much respiratory depression and when its time to wean I think think it takes longer.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
if i'm ever intubated i want the max. it's one of my biggest fears, being conscious and intubated, and i would probably be insanely wild if i weren't completely snowed.

no kidding right? come on propofol!!!

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Specializes in ICU.

LOL! Oh, i told my coworkers if they didn't have me maxed on diprivan with some morphine Q2, I would come back and haunt their a$$es.

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Large teaching hospital. Only with our micu overflow pts will you see q1 hour fentanyl. Our neuro pts that are tubed always have a fent/prop drip. I cringe Iif my micu pt doesn't have adequate sedation. That AC is not something to be awake on. I even came on today to

find my guy on an Ativan drip only.

He tAkes 60mg of oxy bid and

4mg of dilaudid q4hours. I quickly put him on a fent drip.

Just think how you would feel OB full vent support and wide awake, or only getting pushes when you are about to climb out of bed.

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I think our initial reaction as an ICU nurse is to keep everybody snowed. While in practice this makes it easier on the nurse to care for the patient it can result in increased length of stay, increased ventilator days, increased VAP, increased microaspiration, etc.

You would be surprised how many people can do very well with just PRN sedation vs needing continuous sedation. Folks who are on continuous gtts can quickly build up an excess and can take forever to wean (INCLUDING versed....not just Ativan). I don't have a problem with PRN sedation. I mean..I'm in the room at least once an hour anyways so what is the problem with it? Now, that's not to say that if your pt is going buck wild before 1 hour is up and needing more then they probably DO need a gtt for sedation. But you would be surprised how many people can do quite well with minimal sedation on the vent and also have no idea after it's all said and done.

Also, a lot of what we tend to think is agitation is in all actuality delirium. There has been a lot done in the recent past with reducing use of benzodiazepines and replacement with haldol. I've seen the difference night and day with haldol vs Versed/Ativan use.

Just some thoughts!

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Specializes in Trauma/Critical Care.

Dear Fellow ICU Nurses,

If I ever get intubated, Please advocate to keep me on continous sedation and pain medication... (I will do it for you).

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Specializes in CTICU.

What might work for one patient might not work for somebody else's disease process or the situation. For example, I think that if you have a patient ready to be extubated on pressure support then it would be dumb to be given any kind of sedatives/narcotics. Right? Now, you have somebody in assist control and it might not be the same or would it? Uhmmm maybe. Just had a patient recently that was on 400 mcg/hr/fentanyl, 12mg/hr/versed, 30 mcg/hr/precedex, 50mcg/propofol, and was not even touching the patient, breathing over the vent, becoming acidotic, and so on. eventually was paralyzed.

I love propofol. Did I hear Resp. depression? Really don't care If my patient is intubated and needs it. It might drop your blood pressure but I seen work wonders with only 15mcg. I'll take the slight drop in bp.

I love precedex little to no respiratory depression.Also, patients are able to follow commands and respond to verbal and tactile stimulus but fall quickly asleep when not stimulated. What a wonderful drug. However, most patients get super super hypotensive due the decreased in svr.

versed is great for it quick onset and half life. It's a great drug for short term sedation.

Ativan also great. it has roughly double the potency of versed and lack of metabolite activity. Great for long-term sedation.

and can't keep on. I think and sleepy just talking about sedation. night.

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Specializes in ICU.

I worked with one wonderful nurse who I did adore, but we had very differing views on sedation. If her patient wasn't jumping out of bed or trying to pull the tube, she would shut the proposal off completely. We always did like to give our patients to each other (I was nights, she was days) but this always upset me. At night they would not sleep well, may not be jumping out of bed, but they were uncomfortable. Some simply weren't complainers, but how can you be comfortable with a tube down your throat and one down your nose? Once the propofol was off for so long we had to get a reorder, and the docs did not like reorders a night.

So we would always have a friendly debate on whether or not the patient was AC mode if they should have sedation.

I always told her godforbid she was ever in that position, she may just change her mind.

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I work in a Level 1 trauma center in a 32 bed Medical Surgical ICU, we are also a teaching facility. We often use Diprivan gtts as well as fentanyl gtts as our standard sedation, but also use ativan, morphine gtts as well. We do use PRN ativan, morphine, fentanyl and dilaudid IVP to maintain sedation. I feel alot has to do with to treatment plan and if extubation is foreseen in the next 8 hours then PRN would be appropriate. I believe daily awakening is very important to the ventilated ICU pt to check on underlying issues not seen while sedated.

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We have both continuous and intermittent sedation protocols. The intermittent protocol calls for morphine and Ativan IVP, dosed according to MAAS scoring. The continuous protocol is either fentanyl/versed or morphine/Ativan. Some patients do just fine with the intermittent protocol. But it should really be a clinical decision based on the patient's needs, not just what that doc prefers!

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Specializes in Pediatrics, ER.

We use a sedation protocol, usually morphine and Ativan as well....versed is not commonly used at my hospital. We only go to drips for ineffective sedation/analgesia....I've seen an Ativan drip twice in the last six months.

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Specializes in PICU, ICU, Transplant, Trauma, Surgical.

I had a trauma patient last week that the trauma team wrote for PRN dosing of meds to keep RAS at a certain level. Super annoying. Generally, vented patients in our unit are on pain and sedation drips, and we can give additional blouses from the pump if needed.

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