Propofol

"How much sedation is given, and for how long, is important in determining patient outcome as both over and under-sedation can have potentially deleterious consequences. Over-sedation can increase time on ventilatory support and prolong ICU duration of stay. Under-sedation can cause hyper-catabolism, immunosupression, hypercoagulability, and increased sympathetic activity.¹ Haemodynamic responses as a measure of sedation are unreliable in the critically ill patient, hence the need for formal sedation scoring."

Rowe, K.& Fletcher, S. (2008). Sedation in the intensive care unit.

Continuing Education in Anaesthesia, Critical Care & Pain. 8(2),

50-55.

Correct that was from a text book but it was referenced in a text book from evidence-based practice from a committee structure and expert panel who researched sedation.

The book referenced this evidence based work.....

Vender, J. S., Szokol, J. W., Murphy, G. S., & Nitsun, M. (2004). Sedation, analgesia, and neuromuscular blockade in sepsis: An evidence-based review. Critical Care Medicine, 32(Suppl.), S554-S561.

I'm guessing the OP will have trouble providing the proper citation since the info probably came from the professor?

I have been following this thread, and I can't find fault with the OP. The OP is a student, asking what I am perceiving to be genuine questions. While some people have perceived the OP as having said/implied that nurses take the easy way out in using sedation for the nurses convenience, all I see is that the OP raised the possibility that some nurses may do this, and was asking for nurses actual experiences on this matter. I don't personally believe it was necessary to ask the OP to cite a study as the OP did not actually make an argument for less sedation, analgesia, or neuromuscular blockade in mechanically ventilated patients. However the OP did cite references from reputable sources on some of the negative effects of sedation, analgesia, and neuromuscular blockade in mechanically ventilated patients. In my opinion, the OP, a student, merely raised reasonable concerns about a subject he/she is interested in.

Well I will answer the OPs question from a practice point of view. In the ICU, the goal of sedation is to maintain a RASS no lower than -2, light sedation. Where I worked, night shift was notorious for increasing the sedation to keep patients quiet all night. They actually routinely documented a RASS of -3 and beyond which was completely against our protocols. This was for staff convenience and became an issue to the point of people needing to get written up. Now, in defense of the night shift: they were often understaffed and had 3 patients instead of 2. Something had to give. I am not condoning the practice at all, but I can see the other side. Unsafe staffing will lead to unsafe care.

An Error Occurred Setting Your User Cookie This a nice literature review on sedation for mechanically ventilated patients.

Great article! Thank you. My experience with Precedex has been great. I have seen calmer, more alert patients who are easier to wean and experience less delirium.

Very interesting info on the fentanyl alternative. I will read up on that.

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.

THIS, all day and all night!!! I'm usually pretty calm and cool, but if I'm ever given a nurse to keep me calm in lieu of sedation, I might just have to strangle someone.

Well I will answer the OPs question from a practice point of view. In the ICU, the goal of sedation is to maintain a RASS no lower than -2, light sedation. Where I worked, night shift was notorious for increasing the sedation to keep patients quiet all night. They actually routinely documented a RASS of -3 and beyond which was completely against our protocols. This was for staff convenience and became an issue to the point of people needing to get written up. Now, in defense of the night shift: they were often understaffed and had 3 patients instead of 2. Something had to give. I am not condoning the practice at all, but I can see the other side. Unsafe staffing will lead to unsafe care.

I always try to keep my patients between 0 and -2 if I can, but I find a ton of my patients are either a -3 or they are a +2. It's like the continuum from -2 to 1 does not exist. What's the trick in your ICU for maintaining calm but slightly more awake patients? The vast majority of mine are going for their ETT the second they are awake enough to move their arms at all, necessitating restraints since we don't use sitters, which just riles them up even more... I want to use the least amount of sedation that I can but I don't want my patients freaking out, fighting the vent, and struggling in the room either. 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 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.