Propofol

[clarkw12]

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?

[Altra, BSN, RN]

I propose that you or a classmate volunteer to be intubated and on a ventilator with no sedation. I suspect your perspective would change dramatically.

[TheGooch]

I propose that you or a classmate volunteer to be intubated and on a ventilator with no sedation. I suspect your perspective would change dramatically.

LMAO!

[Esme12, ASN, BSN, RN]

Patients intubated on the vent are not sedated for the nurses convenience. These patients are needing sedation so they may rest and heal. When my dad had open heart he said he would do it again if he didn't need to be intubated.

It's the humane thing to do.

[CodeteamB]

One thing I don't see addressed here is the misconception that patient sedation actually makes the nurse's job easier.

First of all, everyone is right about sedation being for the patient's benefit in the case of intubation. ET tube + inadequately sedated patient = panic, and is in my opinion akin to torture. If a patient is on a ventilator, receiving no sedation, and not fighting it, that bodes very poorly for the patient. So let's just assume that sedation with intubation is a given, and the extra work thing is a moot point.

Now, let's imagine an agitated patient. They may require frequent settling, a locked room etc. This may be extra work for the nurse. Now say we take the same patient and sedate him... Now he needs continuous cardiac monitoring, frequent safety checks, extra documentation, close monitoring of sedation level and titration of drips/ dosages, the list goes on.

Unless a patient is at the point of harming himself or someone else it is far less work (if more annoying) for me to have him conscious.

[calivianya, BSN, RN]

The least amount of sedation that keeps a person compliant with the ventilator is really what the goal is. If you are constantly adjusting the sedation to effect and not just letting it ride at a single level forever, there shouldn't be a problem with extended amounts of time on the ventilator because you'd be using the minimum amount of sedation necessary, and that will clear out of a patient's system pretty quickly when it's turned off.

Of course, all of that goes out the window when you've got a family who insists on shaking/shouting/agitating the patient continually to the point that you have to run a higher level of sedation at all times, but that's a whole different story. Sometimes the families are willing to be educated on how to help take care of their family member and sometimes they will fight you every step of the way.

[wooh, BSN, RN]

I propose that you or a classmate volunteer to be intubated and on a ventilator with no sedation. I suspect your perspective would change dramatically.

If I'm intubated, I want all the drugs I can get. If there's a stupid nurse (or nursing student) at my bedside trying to calm me down, I'm going to be even more agitated and need MORE drugs.

[Altra, BSN, RN]

As an alternative, OP ... you can do this experiment:

Stick one finger as far back in your oropharynx as you can. Remain in that position as long as you can. Consider what that feels like, physically and psychologically. Or, recall the sensation the last time you choked on a piece of food.

Still think that sedation is for the "convenience" of nurses and not for the patient's benefit?

[clarkw12]

are you kidding me, I never said I thought it SHOULD be used for the convenience of nurses. I never said sedation SHOULD NOT be used. I am just bringing up the point that sedation is sometimes over used and when it is it can cause patients to have longer hospital stays. Under-sedation can also be a problem for the patient. Both sides need to be looked at and weighed in order to get the appropriate care for patients, thus the purpose of this forum. I work in an ICU and the focus here is using the least amount of sedation possible for the benefit of patients recovery time. I appreciate all the constructive and informative remarks.

[KRVRN, BSN, RN]

How the heck did a reasonable question from a student as to what ICU nurses have seen turn into Hey OP clark... How would you like to be intubated? Try it and see! Yikes.

[traumaRUs, MSN, APRN]

Back to the topic. Can you cite a study where sedating a pt lengthens the intubation duration? (As a nursing student you will be asked to cite research to back up opinions).

[Esme12, ASN, BSN, RN]

are you kidding me, I never said I thought it SHOULD be used for the convenience of nurses. I never said sedation SHOULD NOT be used. I am just bringing up the point that sedation is sometimes over used and when it is it can cause patients to have longer hospital stays. Under-sedation can also be a problem for the patient. Both sides need to be looked at and weighed in order to get the appropriate care for patients, thus the purpose of this forum. I work in an ICU and the focus here is using the least amount of sedation possible for the benefit of patients recovery time. I appreciate all the constructive and informative remarks.

actually yes you did.

clarkw12 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

While you may work in the ICU and hear nurses off hand comments, you are NOT a nurse.....As a STUDENT you cannot possibly have the complex understanding about the care of the ICU patient and the intricacies of the care of the critical patient. While the nurses may quip that it is nite nite time so they can have a break...it is still in the patient best interest to not allow them to buck the ventilator, possibly cause Barotrauma which can lead to ADRS...which IS a detriment to the patients care. Another factor is the restless patient is the constant movement causing a rise in the CPK from muscle damage/fatigue which can lead to Rhabdomylosis....

which can lead to renal failure.

ALL medical interventions have their price and you weigh the pros/cons of the situation for the best benefit with the least risk.

IN 35 years I have NOT seen nurse sedate patients just so they can get a break because they are lazy....it has been because other methods of calming the patient have failed and the patient is being terrorized and harmed by their restlessness.

[clarkw12]

Patients who require mechanical ventilation commonly require sedation and analgesia. Neuromuscular blockade is also needed for some patients. Although pharmacological support is an important intervention, administration of analgesics, sedatives, and neuromuscular blockade often results in prolonged mechanical ventilation and related consequences such as ventilator-associated pneumonia.

Sole, M.L., Klein, D.G., & Moseley, M.J. (2009). Introduction to critical care cursing

(5^th ed.). St. Louis, MO: Elsevier.