ICU sedation

• related: ICU intensive care unit
• tags: #icu

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• extubating patient without cuff leak
• ECMO patients are harder to sedate and harder to wake up because of lipophilic circuit?
• adequately sedate patients who are initially intubated with RSI
• fentanyl can have tachyphylaxis response that dilaudid does not have

Propofol

• propofol infusion syndrome is associated with high dose continuous infusion
• use propofol and precedex combination to minimize agitation and delirium
• stop propofol when triglycerides are over 500?

• analgesics (pain) vs anxiolytics (sedation)
• IV push vs drip
• RASS goal? Stay in 0, -1, -2

Precedex

• use propofol and precedex combination to minimize agitation and delirium
• DahLIA trial found precedex helps earlier extubation in agitated patients
• spice III found higher mortality in younger patients with precedex

Anxiolytics

	Push	Drip	Dosing	Indication	Caution
Propofol		xx	0.5 mcg/kg/min 0-100mg	- drug of choice - fat soluble - short half life	-hypotension>bradycardia - propofol infusion syndrome - hyperlipidemia
Versed midazolam	xx	xx	0.04 mg/kg/hr	- sedation - ETOH withdrawal on vent - seizures	- hypotension - delirium - accumulation in fatty tissues - liver renal dosing
Ativan Lorazepam	xx		0.04 mg/kg/hr 1-4mg IV Q3 PRN	- ETOH withdrawal - seizures - CIWA	- same as Versed - propylene glycol toxicity (no drip)
Halodol	xx		5-10mg IV Q4-6 PRN	- delirium - agitation	- long QT - EPS
Precedex Dexmedotramidin		xx	0-0.7 mcg/kg/hr	- delirium - agitation - weaning off vent	- bradycardia>hypotension - cost
Ketamine		xx		only status epilepticus

Analgesics

	Push	Drip	Dosing	Indication	Caution
Fentanyl	xx	xx	25-100 IV PRN Q2 0.1-4 mcg/kg/hr	- drug of choice - short 1/2 life - BP neutral	safe short 1/2 life
Dilaudid	xx	x	0.5-4 mg Q3	- opioid experienced - sickle cell	hypotension
Morphine	xx		5-10 mg IV Q3	- rarely in ICU - terminal weaning - air hunger suppression	hypotension histamine release itching renal failure

Links to this note

• ICU intensive care unit
  • ICU sedation
• spice III found higher mortality in younger patients with precedex
  • related: SBT and SAT spontaneous awakening and breathing trials, ICU sedation
• propofol infusion syndrome is associated with high dose continuous infusion
  • related: ICU sedation
• adequately sedate patients who are initially intubated with RSI
  • related: ICU sedation
• use propofol and precedex combination to minimize agitation and delirium
  • related: ICU sedation