Propofol

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I was just wondering what everyone here thinks about the use of propofol for pateints on ventilators. I can see both an upside and downside to using this medication with patients on ventilators. On the one hand it makes the nurses job much easier as the patient is relaxed and not pulling at the ventilator all the time, also posibly helping with patient safety. But on the other hand it seems like it might take the patient much longer to wean off the venilator and increase the likelyhood of hospital acquired pneumonia. What do you think? Let me know what you have experienced?

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Homework question? What have you seen?

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Specializes in SICU, trauma, neuro.

Are you asking about sedation in general, or Propofol specifically? Are you a student or new ICU nurse? (If you are a student, props for sharing your thoughts while asking!)

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Propofol is prescribed by the attending physician. The use of the medication depends on the benefits to the patient in the current setting.

You statement that "it makes the nurses job easier" is concerning.Nursing is NOT about making the job "easier". It's about what the ventilated patient requires.

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Specializes in Trauma/Tele/Surgery/SICU.

Clark, I am going to assume this is indeed a homework question. That is not a bad thing you will just find that most of us here like to help students hone their critical thinking skills rather than give out answers directly. It looks like you have put some thought into benefits vs risks with your statements about patient safety and potential for longer weaning times. However you have missed the biggest benefit sedation gives to the mechanically intubated patient.

Sedation whether propofol or not has nothing to do with making the nurses job easier. Any medication should be prescribed for the benefit of the patient, not staff.

Why might someone need to be intubated. What are we trying to fix? What do you think it feels like to be intubated? How do you think a patient may react to that?

Just a few questions to get you thinking. Post back and let us know what you think.

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Specializes in SICU, trauma, neuro.

Generally if someone is intubated they will have orders for sedation. It has absolutely nothing to do with what is easier for the nurse...can YOU imagine being intubated with nothing to help you relax? Someone who is terrified with no sedation at all is going to get exhausted, and it will be harder to wean them. He could very well extubate himself. And this is just my thought--I haven't read research on it or anything--but think of the increased alarms from someone who is constantly bucking their vent, biting their tube etc. They will be very, very frequent, contributing to delirium in pt's and alarm fatigue in staff (a very real problem--not about "easier.")

The nice thing about Propofol is it has such a short half-life that it can be weaned quickly for daily sedation vacations, to decrease the risk of delirium and so that the pt can pressure support, thus helping get them off the vent sooner.

What we do is titrate the drug to a RASS score of -1 or -2 ("drowsy" or "light sedation.") This way the pt can be weaned more easily, is less at risk for delirium, and is able to communicate with staff that they have a need. Pain is one example. Propofol makes someone look like they're asleep, but does NOTHING for pain control. If they're lightly sedated but having pain, they are still able to shake their head yes/no or give a thumbs up/thumbs down when the nurse asks about their pain.

And if the pt isn't able to be weaned and extubated, they get a trach in a fairly short period of time. When they're trached and on the vent, they are not sedated with drips; they just get PRNs for anxiety, maybe scheduled Seroquel if anxiety is constant.

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Specializes in Anesthesia.

You need to look at the context sensitive half lives of the different drugs to really understand why we use different infusions to sedate patients long-term. Context-sensitive half-life - Wikipedia, the free encyclopedia This is different than what you will find in most drug books and specifically deals with infusion half-lives versus the half-life after single injection/bolus.

Propofol is usually going to have shorter context sensitive half-life than most traditional infusions used for sedation i.e. Versed and Fentanyl.

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Specializes in MICU.

It has a short half life and pts usually wake up within minutes of being weaned off. So compared to Ativan it's better because it won't build up. I've seen a handful of pts have extra vent days due to Ativan (continuous gtt and I've push) but never propofol. The big disadvantage is that propofol isn't really supposed to be used long term. It also lowers BP.

The reason we sedate vent pts is mainly to increase compliance with the vent. If they're fighting we can't ventilate them like we should be able to.

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Specializes in Anesthesia.

Propofol can take minutes to over 24+hrs to get out of the system. It can take patients hours to wake up enough from being sedated with propofol to be able to wean the patient off the ventilator. http://anaesthesia.co.in/wp-content/uploads/2012/05/Propofol.pdf I think the new drugs for long-term ICU sedation will eventually be remimazolam and remifentanil since both are ultra-short acting even when given as an infusion. Remimazolam isn't approved by the FDA in the US, but hopefully will be this year. Remifentanil is currently being used for ICU sedations in place of Fentanyl. Remimazolam - Wikipedia, the free encyclopedia Ultiva (Remifentanil) Drug Information: Description, User Reviews, Drug Side Effects, Interactions - Prescribing Information at RxList Sedation and Analgesia in Intensive Care: A Comparison of Fentanyl and Remifentanil

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That is one reason I posted the question, in our class it has been discussed and I have also seen, that sometimes healthcare doesn't necessarily do what is best for the patient in the long term but instead takes the easy/convenient rout. I understand that nursing is not about making the job easier for the staff, but that doesn't change the fact that nurses might use the medication to calm their patient down so they don't have to constantly be at the patients bedside calming them down. In some instances that may be for the long term benefit of the patient, but I am sure it has been used just to make life easier on staff. I am not suggesting that that is right, I just wanted dialog and to see what people have seen.

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I am a student and just wanted to see what people have seen/experienced in the use of sedation with ventilators. In our class we have discussed that it is concerning how sedation is sometimes used and that it can actually lengthen the time that patients are on ventilation.

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Specializes in Anesthesia.

I wouldn't judge too harshly until you have been in their situation for awhile. What looks wrong or right now might not be so clear cut later.

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