Sedation in ICU... your opinions/ experiences?

Specialties MICU

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Just wondering, how many of your vented pts are sedated, and with what? Are there certain pts that you always do or do not sedate, or is it always a case by case basis.

Most nurses on my unit would agree that we do NOT sedate people enough. Of course, I know we shouldnt be snowing every pt in the unit, lol. Nobody gets propofol, if they come in on it they have us stop it. They typically don't order anything continuous right off the bat... maybe they will order something Q1hr PRN and then when you explain how it doesn't make sense to be in there pushing fentanyl every hour, then you may get a continuous PCA dose.

We do end up with quite a few people on continuous Fentanyl, usually running at 50-100, maybe up to 200 after they are on it long enough and still sitting straight up in bed.

Rarely we might have a mg or two of Versed on board as well.

The only exception would be our pts on bilevel- most times they are very well sedated and paralyzed.

... they keep trying to make plans to help decrease our # of unplanned extubations (big problem in our unit) but none of these plans involve adequate sedation.

Ugh! Some nights I feel like I'm in the rodeo. Plus, we have all private rooms, so if I'm stuck in one, have no idea whats going on in the other until alarms are going off.

Opinions/ experiences/ advice??

As for neuro patients, we had a wonderful neuro-intensivist who would order propofol for these patients. We would simply turn the drip off for a little while to do neuro checks. His reasoning for ordering sedation was to reduce ICP spikes.

As a student I did a placement in one of the countries biggest/most respected neuro ICUs where this was the norm. It seemed to do a good job. Comfortable however assessable patients.

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