Sedation..Your thoughts?

[Da_Milk_of_Amnesia]

So I just have a question for my fellow icu RNs. I had a patient last night who while even sedated on 50mcgs/kg/min of propofol and 6 of versed was able to open eyes and follows commands and respond appropriately. I asked her several times if she was comfortable to which we nodded 'yes'. Her Peak pressures were all fine in, her HR was 90s-100s, which is better than the 110-120s she was when she got to me and her BP was now 100-110s which was better than the 70-80 when she got to me (septic, severe PNA). I made the decision to not call the MD and not add anymore sedation to her. She was triggering the vent at a rate of 20-22 on PRVC. So my question is, what would have you done? I know some people like to have their patients snowed wayyy down, but I don't like to. She was a young girl in her 30s, and since she was hemodynamically stable (on only 2.5mcg/min of levo, down from the 10mcg/min she was initially on) I decided to keep her where she was. I know it's a judgement call and everyone will have their own opinion on what they would have done, but i am curious to know. Thanks.

[meandragonbrett]

Has any of you been on a ventilator? Why in heavens name would you not want to "snow" your patient until they are ready to come off the vent?

Increased risk of VAP secondary to increased ventilator days? There is plenty of research that has related depth/length of sedation to increased ventilator days.

There is no reason to keep somebody totally snowed. The goal of sedation is to keep the patient comfortable but easily aroused to tactile stimulus.

I've had patients that are on the vent and be 100% awake, intubated, and watching TV with just some occasional ativan for anxiety.

[dorie43rn]

Increased risk of VAP secondary to increased ventilator days? There is plenty of research that has related depth/length of sedation to increased ventilator days.

There is no reason to keep somebody totally snowed. The goal of sedation is to keep the patient comfortable but easily aroused to tactile stimulus.

I've had patients that are on the vent and be 100% awake, intubated, and watching TV with just some occasional ativan for anxiety.

I've worked the ICU for five years and have never seen diprivan increase the length of ventilation. Ativan does, it takes so much longer for it to leave the body.

If they are awake and accepting the vent, good for them, but if they are bucking the vent, totally uncomfortable, then they need sedated until they are no longer uncomfortable.