Ventilator Sedation in the ER LMH ER ROUNDS PREPARED BY SHANE BARCLAY.

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Presentation transcript:

Ventilator Sedation in the ER LMH ER ROUNDS PREPARED BY SHANE BARCLAY

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…

The End Questions ?