ventilator sedation in the er lmh er rounds prepared by shane barclay
TRANSCRIPT
Ventilator Sedation • Standard treatment of intubated critically ill patients was
continuous sedation, with some analgesia (and in the past even paralysis).
• Lancet 2010 “A protocol of no sedation for critically ill patients receiving mechanical ventilation”.
• One group received sedation (Propofol then midazolam infusion) and analgesia (morphine).
• Other group treated with only analgesia (morphine), no sedation.
• The no sedation group had statistically less days on the ventilator without any more complications than the sedation/analgesia group.
Ventilator Sedation
•Message is that intubated patients have PAIN if for no other reason that we have stuck a piece of rigid plastic down their throats.
• So give intubated patients a bolus of morphine or fentanyl right after the intubation or during your RSI.
Ventilator Sedation
Fentanyl Protocol:
Start with 25 mcg bolus and 25 mcg/hr. If still pain then give 25 mcg bolus over 3-5 minutes and increase infusion by 25 mcg/hr.
Maintenance dose is usually in the 25 – 150 mcg/hr
Ventilator Sedation
Morphine Protocol:
Start with 0.8 mg/hr.
If still pain, may give 2 mg morphine over 4-5 minutes and increase infusion by 2 mg/hr.
Maximum dose is 150 mg/hr.
Ventilator Sedation
Once the patient has analgesia (fentanyl or morphine)
Then you can give small doses of sedation.
Sedation:
Can be midazolam, ketamine, lorazepam, diazepam…