Using Propofol for sedation on vented pts?

[Scrubz]

Is Propofol used on vented patients? Since the half-life of Propofol is so short wouldn't it be more justified using a longer activing sedative? I assume that Propofol isn't used for long-term vented pts right? Maybe just initially?

I'm still in school so I have no experience with any of this other than what I hear or see, so thanks for any responses. I was just curious.

[Myxel67]

We always used propofol on vented pts who required neuro checks.

[fsutallyrn]

We use propofol on our vented patients to. I also like it because of its short half life. We tend to use it only short term though (less than 7 days) because it raises the patients triglyceride level and can put them into pancreatitis. We typically check triglyceride levels every 48 hours, and if elevated switch to versed. We hold lipids for the TPN if on propofol as well because of its own contibution of lipids. In addition to the sedation medications we also give pain meds . Many times the patient receives a fentanyl drip with the propofol or versed. Fentanyl also has a shorter half life than other pain meds. I believe I recently read in a study in the Critical Nurse journal that as many as 87% of mech vented patients have unmanaged pain. I often find that when I use both pain meds and sedation I use less of both. I think they potentiate each other. The patients tend to wean faster for me if I use a combination of things judiciously. Good Luck everything is a fine balance.

[gradcare, LPN]

I like the "milk of human kindness". Major problem with long term use though is that you can get into the situation where you need more to get the same effect over time (tachyphalaxis [i think I got the spelling right]) also in larger doses you can get a propofol infussion syndrome which can get pretty nasty with cardiac involvement and acid-base derangement (I have only seen It do this in anaesthetic doses however) Kids PIS has been fairly well doccumented in various magazines. But for short term sedation propofol/fentanyl or propofol/alfentanyl/cisatricurium is great for roadtrips/ short procedures. Mind you it is a good idea to have aramine or similar standing by incase of hypotension.

[RN_MIKE]

we tend to convert most everyone to fentanyl/versed if they will be vented for awhile.

[faith716rn]

The very first thing I learned when transferring to ICU 4 years ago was, 'propofol is your friend.' That's been proven to me time and time again for all the reasons previously mentioned!

[nrsang97, BSN, RN]

We use propofol a lot in the Neuro ICU due to the short half life. It can be turned off so we can do a neuro exam and turn it back on. We have been giving it with fentanyl lately and seems to work rather nicely. Diprivan is the brand name for propofol so that is where they get the name Vitamin D. I like the milk of amnesia nickname.

[BethAn]

We've never used propofol in our MICU. It's always Fentanyl and Versed. I guess I've always wondered why we don't use it, as I've heard other nurses talk about how great it is.

Anyone know possible reasons not to use it...more expensive? long term use causes liver damage perhaps??

[oMerMero]

Propofol is more expensive than other drugs available. My guess is that is why your hospital does not use it.

[BethAn]

That sounds about right. MICU=highest acuity and lowest amount of revenue for the hospital. Always trying to save a buck.

[*AlexRN*]

I have a question about propofol ... it is a sedative... so it does nothing for pain, correct?

I ask this because I had a patient on a ventilator (I'm still a student) that required neuro checks... you could tell he was in pain because they had to put this corset on him...30 minutes after they put it on, he was restless, and his bp, HR went up, along with respirations...he just looked like he was in PAIN... he had morphine PRN, but they called the doc and started him on a propofol... and by the way my instructor put it, it does nothing for pain, but he's just too sedated to show it.

I don't understand why they didn't just use the morphine? We ended up slightly loosening the corset, and that helped a little bit.

[cardiacRN2006, ADN, RN]

What a shame that they didn't give him the PRN morphine. What was he on for sedation prior to the propofol being started?

[Ophelia78]

You are correct, Propofol is a sedative/hypnotic only- it does not provide pain relief. Patients who are sedated should be closely monitored for nonverbal signs of pain, since they will most likely be unable to communicate that they are having it. It is the policy at our hospital that patients receiving continuous sedation also receive a fentanyl or morphine drip for continuous analgesia.

Most of our vented patients start out on a Propofol drip, but our policy only allows for 48 hours. After that, everyone is switched to an Ativan drip. Our PharmD gives the reasoning for this as the risk for increased triglycerides and Propofol Infusion Syndrome, though quite frankly, at the last ICU I worked at we used Propofol for longer than 48 hours and I never heard of anyone developing that syndrome...