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 ?