Sedating the ventilated patient Adult chatting on ipad
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.
The normotensive patient that becomes hypotensive on sedation is markedly common, and unfortunately many respond by simply adding some wrist restraints and cutting back on drips.Some departments may have restrictions on certain opiate drips, such as Fentanyl. Fentanyl has the unique advantage of creating more than analgesia – it can create hypnosis for certain patients.Fentanyl, as a synthetic opioid, also has the benefit of having no histaminergic reactions, nor does it have active metabolites2.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.
In the “good old days,” trying to achieve those two goals under these conditions was often met with a slight dose of paralysis – vecuronium at times – while maintaining ventilator synchrony, mixed with a few pushes of benzodiazepines to relieve anxiety and hopefully introduce some amnesia.