Sleep cycle while sedated on propofol

[mochamonster]

Hello everyone,

It is my understanding that patients still experience sleep/wake cycles while sedated on propofol. However, I am having difficulty finding more information about this. I am curious if measures can be taken when a patient is sedated to prevent/minimize/correct ICU psychosis in patients who have been sedated for long periods of time and aren't receiving the normal cues for the sleep/wake cycle. I've already had patients moved to the east side of the unit to get morning sun, and tried other cues to encourage less sleep during the day, and I know night shift tries to make things as quiet and restful during the night as possible (though I know that is difficult or impossible many times). We also do sedation holidays every shift if stable enough.

Your thoughts and info are appreciated!

Mochamonster

[Biffbradford]

Things to do after the sedation is stopped? Right?

[mochamonster]

Usually after, yes. What is prompting me to write this is a patient that has their days and nights so mixed up that they sleep all day and then they are a wild banshee all night. Unfortunately they had to be put back on propofol because they are so agitated. They are hallucinating and clearly have ICU psychosis, but all the psych meds seem to do nothing for them. Add to that they are a hard headed personality per the family. We just keep trying to get them off the propofol, but they seem to keep taking a step back physiologically from their agitation. So, yes, ideally off sedation, but even when they are sedated at times. This patient seems to be having more trouble than most, and I feel they can't help it either.

[sapphire18]

Can you elaborate why you want them off the propofol? I'm assuming they're vented...is it a long term or permanent situation? Just do what you would do for any other pt: minimal stimulation at night, activity during the day. There are more tricks to use too, but it is very difficult to correct ICU psychosis while still in the ICU. Sometimes a change in environment is the only thing that can help.

[jmdRN]

In our ICU our intubated patients have sedation protocols where we give less sedation in the daytime (say a 2 or 3 on the Ramsey scale) and deeper sedation (5 on the Ramsey scale) at night.

[Biffbradford]

Does this patient follow commands and make purposeful movements, or just act crazy?

Any reason to question brain damage to some degree (hypoxia or extended hypotension) that might warrant a head CT or EEG?

Got a neuro consult on board?

Just say'n that maybe it's more involved than just just trying to re-orient them.

[optimissrn]

Geodon is helpful for ICU psychosis...works best IM.

I was told that Propofol is the only sedation that puts a patient in REM sleep, therefore, they wake up feeling more rested than other sedatives.