Sedating the ventilated patient
In “The ICU Book,” Marino states “the common denominator in these conditions (anxiety and delirium) is the absence of a sense of well-being.” Reducing anxiety on a ventilated patient is challenging.
Double breathing the ventilator, pulling at lines and persistent tachycardia are all obvious signs of anxiety.
Goal #1: Pain Relief The first goal is easily the most important and most practical: a hard plastic tube in the oropharynx hurts, so give pain relief.
While the concept of pain is simple to understand, it is easy for a physician to forget to provide analgesia.
But your nursing manager then informs you that the hospital is full, including the ICU.
So now your severely septic patient will be boarding in the ED.
Fortunately, as emergency medicine knowledge progressed, so did pharmacology, and now the idea of paralyzing an awake patient brings chills to us all.Providers will often put on the milky potion of diprivan and forget that it has no analgesic properties.Similarly, if the patient becomes hypotensive, the Fentanyl drip will be reduced, instead of maintaining a comfortable patient and starting vasopressors to main hemodynamics.A 70-year-old male comes to the emergency department via EMS febrile, with worsening respiratory distress and altered mental status.You quickly diagnose him as having severe sepsis stemming from pneumonia, and initiate treatment.
Rather than having only the extremes – pulling out the tube versus completely limp and comatose – the goal now within the ICU is to maintain a patient comfortably sedated at a RASS of anywhere from 0 to -3.