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?

[ICULINDA]

We use propofol and fentanyl. I've noticed we are moving more towards precidex and fentanyl. Depending on the patient we may use versed and fentanyl. I know I would have bad anxiety and freak out if I woke up intubated I would pull my ETT out. I do try and titrate to the lowest dose and our docs will through in some PRNs to try and help with anxiety as we titrate down. It's still hard on the patient though. We have given lidocaine to swab the throat so the patient doesn't feel the tube as much. This helps with some of the "choking" feeling. The ones that are awake say the choking feelings are the worst. Family presence helps. The patient knows the family voice and is sometimes able to help distract them or keep them calm when we do SBTs.

[Here.I.Stand, BSN, RN]

I'm wondering if it's because we typically only use propofol as far as our sedative/analgesic drips with q1h pushes of analgesics/amnesics/paralytics available if necessary, and if another drug or combination of drugs would allow more awake and compliant patients...

We do use a narcotic gtt (usually fentanyl) with most of our pts; sometimes they have an epidural too. Maybe it's different b/c we have so many multiple traumas in my ICU, and it's expected that they're having a lot of pain. I recently read a study in favor of light sedation (vs. moderate or deep--not vs. none), and one of the points they made was if the pt is not completely out their pain will be better controlled.

If they're on neuromuscular blockers, we are very liberal with the sedation! Plus have them on a BIS monitor to verify their level of sedation. I can't imagine many things more terrifying than being completely paralyzed and completely aware.

[KRVRN, BSN, RN]

In school I saw an ICU pt that had sustained a frontal lobe brain injury in a MVA. He was vented, trached, still in a c-collar and very brain injured/altered. The nurses said he was very "frontal." I remember them saying that he was becoming resistent to the sedation, but the doctors wouldn't change it. While I was there he completely woke up, sat up and tried to get out of bed. It took 6 of us to hold him down. The chief resident was right there and ordered a paralytic. That poor guy was instantly diaphoretic and his HR skyrocketed. It was the first time I had seen a paralytic given and my God what a dramatic effect.

[nursey246]

I LOVE PROPOFOL! If you are diligent in your oral care, HOB position, and suctioning, your patient should not get VAP related to propofol use. This medication is so great for patients in status and those with elevated ICP that need to be chilled out while their brain calms down. And it's so great for neuro ICU patients because of how quickly it wears off to get a good neuro exam and how quickly it starts back up once you turn it back on. Now, my struggle is when pain medication is not appropriately used in conjunction with propofol. Many patients with an ETT are also in pain, and you should always address pain before sedation. In my experience, the physicians are on top of lightening and discontinuing sedation as soon as it's clinically appropriate, so the whole "using it because it makes it easier for the staff" thing isn't an issue.