The Intern At Work: Internal Medicine 101. Biting the Bullet - Sedation in the ICU
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Aug 8, 2021 Exploring the history and principles of sedation in the ICU, including terminology and measurement methods. Discussing sedation protocols, common sedative agents, and associated risks. Exploring sedation practices, utilization of Acetamine for patient transport, and shift towards lighter sedation objectives. Emphasizing the need to assess outcomes like self-extubation and PTSD in survivors.
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BIS Is Adjunctive, Not Definitive
- Objective monitors like the BIS can help when patients are paralyzed but have reliability limits.
- BIS readings may be contaminated by EMG and should not replace clinical assessment.
Use Light Targets Or Sedation Vacations
- Target light sedation (eg RASS −2 to 0) or perform daily sedation interruptions to minimize drug exposure.
- After a sedation break, restart medications at half the previous dose and reassess.
Match Drug To Patient Physiology
- Know each sedative's pharmacology, hemodynamics, and kinetics before choosing therapy.
- Agent selection affects blood pressure, inotropy, duration, and accumulation risks.