There is some literature that has come to show benzodiazepines may worsen delirium17. Delirium in the ICU may seem like a distant thought to the ED physician, but literature has shown that delirium leads to longer ICU stays and increased mortality18-20. 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. Understanding the RASS makes sedation more plausible and greatly improves communication when signing out that tough sick, intubated patient. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. The agitated patient with elevated peak pressures would roll their eyes back and relax on the ventilator. Unfortunately, the long-term effects were hidden to the ED. Benzodiazepine versus nonbenzodiazepine-based sedation for mechanically ventilated, critically ill adults: a systematic review and meta-analysis of randomized trials.
Fortunately, as emergency medicine knowledge progressed, so did pharmacology, and now the idea of paralyzing an awake patient brings chills to us all.After setting up and preoxygenating him, you have first-pass success on your intubation, pat yourself on the back, and admit him to the ICU.How to reduce anxiety and improve comfort while not oversedating.Other scales, such as the Riker Sedation-Agitation Scale (SAS) and the Ramsay scale, are also available. The goal is to have an objective scale that can be used to communicate between the ED and the ICU. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. Sedation Scales Before discussing the second point, one key scoring system must be understood. Devabhakthuni S, Armahizer MJ, Dasta JF, Kane-Gill SL.The Richmond Agitation Sedation Scale (RASS) is a useful tool for assessing ventilated patient arousability (table 2). Critical Care Pharmacotherapeutics, Jones & Bartlett Publishers, Feb 8, 2012, chapter 5, pg 92 – 95 23. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Analgosedation: a paradigm shift in intensive care unit sedation practice. 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.