Sedation is one of the details of ICU care which seems unimportant… until it's not. Over the past decade we've seen a burgeoning repertoire of agents used for sedation and agitated delirium. Unfortunately, the number of medications has out-stripped available Level-I evidence regarding how exactly to use them. This chapter attempts to create a framework for the selection and use of various agents. Looming drug shortages due to COVID-19 may force us to push the envelope, by using different agents in ways which we haven't previously.
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Incredibly helpful chapter as always. I have learned a tremendous amount from your posts and have been able to apply the knowledge gained to numerous cases in our dept. Thank you for what you do.
fantastic work! may want to add status epilepticus to midaz infusions indications
Helpful as always! Excellent
we use form time to time sedation with inhalational anaesthetics in the intensive care unit with the AnaConDa® device. somestudies have shown superiority of volatile anaesthetic agents over intravenous drugs for ICU sedation. it give you shorter time on ventilator and could be discharged from icu faster. it may help in status asmaticus, and ARDS ( RCT is comming). and the cost is low. here in EU is used allot in Germany and france.and we here in denmark is starting.
“This is not referring to conscious sedation for procedures, where propofol can be used for short periods with intense monitoring.”
Using propofol for procedural sedation is at deep sedation level. Conscious sedation is a lighter level of sedation, commonly midazolam and/or fentanyl are used. reference Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia | American Society of Anesthesiologists (ASA) (asahq.org)
I would recommend change the wording from conscious sedation to deep sedation in that sentence.
Is anyone using Spontaneous Awakening Trials daily on all vented patients? Or simply aiming for a RASS of -2 – 0 at all times?
2 scenarios:
1) pt RASS 0. Able to SBT and do PT. Not able to liberate from vent. Propofol is 20. Fent is 100. Next step?
2) severe ARDS. RASS -2. Prop 60. Ketamine 20mg/hr. Fent 150. Hx of significant vent disynchrony. Next step?
Thanks for tour input.
Jarrett
Here is this little pearl I just found on Propofol’s page regarding Valproate: use it to reduce your propofol load?
“The concomitant use of valproate and propofol may lead to increased blood levels of propofol. Reduce the dose of propofol when co-administering with valproate.”
https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/019627s066lbl.pdf
Great guide !
What about the usage of opioid analgesics for sedation (fentanyl) though ?