vents and sedation?

Specialties MICU

Published

I work at a smaller hopital in a 12 bed ICU. We frequently have patients who are unsedated on the vent. I am new to the ICU, but I thought sedating vented patients was pretty much standard of care.

I asked around at work and some of my co-workers told me that if the patient seems content no sedation is necessary.

So how common is this? What is standard of care for sedation and vents? Thanks in advance for your input.

Specializes in MICU, ER, SICU, Home Health, Corrections.

How about a side note...

What's everyone's protocols for sedation with the initial intubation? I just got home from work where my last act was to take a MET call out on the floor, and watch grandma-in-her-makeup-CRNA with standard-issue surgery attitude begin an intubation.

She had good skill of course, but my problem was with her standing bolt upright and striking a pose to give me a very long, quiet, dirty look when I asked if we going to give the guy anything [as I watched him weakly struggle and bite down on the blade]. He had no energy to fight, but was wide awake.

She was so cool, she used a Mac blade about half in the oropharynx with the guy biting teeth on it, and succeeded on the first try. Excellent manual dexterity.

Woopty freakin doo. She really showed me.

...and left the patient a nice memory too.

These surgery people make me want to puke; all nice and clean, 3 people with a large trauma bag full of God knows what; [one person to tube, one to do cric pressure and one to dig in the bag], coming in to do a low-level ACLS skill like it's some awe-inspiring feat, and we should drop and give thanks.

I say she can come ride with me one shift and try her little trick alone in the pouring rain through the sunroof of a car lying on it's side.

I'm betting she won't be so cocky then.

Anyway, the issue is the questionable treatment of the patient. Just because one isn't ABLE to fight you off, they get no sedation or even 'twilight' meds...?

Am I asking too much here?

Sorry for the venting but that just gets my goat.

rb

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Specializes in gen icu/ neuro icu/ trauma icu/hdu.

re:sedation,

most people who are ventilated will be sedated initially (I've seen polypharm o.d.s and iv od's who provided their own and were tubed "dry" or flat. Simply put sedation needs to be light enough to assess the patient and begin weaning when appropriate but "heavy" enough to maintain patient comfort. I have seen only 2 general exceptions 1 head injuries with sedation used as neuro-protection and 2 burns (nuff said)

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Specializes in ICU.

We've had quite a few patients who weren't sedated for several reasons. Sometimes their BP couldn't tolerate it and we had to just try other ways to make them comfortable as possible. Sometimes, they just didn't need it and would just sit their watching TV while the vent breathed away for them. Our intensivists are all about comfort which for different people means different things and sometimes they just don't need it.

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Specializes in Critical Care, Emergency.
We've had quite a few patients who weren't sedated for several reasons. Sometimes their BP couldn't tolerate it and we had to just try other ways to make them comfortable as possible. Sometimes, they just didn't need it and would just sit their watching TV while the vent breathed away for them. Our intensivists are all about comfort which for different people means different things and sometimes they just don't need it.

why not try versed/fentanyl? these rarely affect BP unless extremely large doses are used. you can get good control with adequate dosing. what may occur is bradycardia with fentanyl, but other than that, shouldn't be any issues.

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Specializes in icu.

We use propofol in our ICU with daily wake ups done on everyone as appropriate. Occassionally we have docs who will order sedation stopped and then we have issues with the pt becoming extremely anxious. I say keep the pt sedated until you are ready to wean - I wouldn't want to be awake with a tube in my throat!

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Specializes in cardiology-now CTICU.

this is a HUGE peeve of mine. pt vented with no intention of weaning to extubate, NOT tolerating the vent, going wild levitating off the bed with a fresh sternotomy and the doc's say no to sedation. it's a huge pt safety/comfort issue in my mind. this is a problem particularly on the unit i work in now.

facility protocol is bolus sedation initially, if necessary on gtt with daily wake-ups.

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Specializes in CRITICAL CARE.

Hi all,

Sedation for the ventilated pts depend on the stage of the patient. If a pt had MI and we have to intubate him than it is always better to sedate him because unsedated MI pts struggle with respirator thus increasing cardiac workload. On the other hand if we are weaning the pts its very important to keep him off sedation with sufficient time so he will be not drowsy at the time of extubation. But always we nurses should carry out sedation score assessment during the sedation. I am working in a sicu+micu, trhis is the protocol we are following.:balloons:

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I love propofol. Works well with most patients. It is a huge pet peeve of mine to come in and get report on a vent patient who is practically coming off the bed and when I ask what they are getting for sedation the dayshift nurse replies "Ativan 2mg Q4 hours PRN." As if that counts or something. :uhoh3:

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Specializes in icu,ccu, er, corrections.

This is off subject, but had a trached and vented patient that slept on his stomach.......really never could figure out how he did that

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Specializes in Neuro, Critical Care.
It's very rare that our vented pts aren't sedated.

ours either. We actually have icu protocol stating if a pt is vented they should be sedated. That being said, I still have to "wake them up" every so often for a neuro assessment and if the tube isnt bothering them (which is rare) then I won't sedate them any further...ive only had one pt that indicated to me that the tube didn't bother him.

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Specializes in SICU.

I know this reply is a little late but...just to add to the thread....Most situations depend on the status of the patient and the team's plan. If they are planning on weaning to extubate sedation may delay that process. We place most patients on propofol and low dose fentanyl most of the time even if they are just remaining intubated overnight. We have started using a new medication called precidex which helps with the anxiety while being intubated but doesn't suppress your respiratory drive. It must be turned off though within 6 hours of extubation per our protocol.

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