Mechanical ventilation - Patient Considerations

SEDATION AND MUSCLE PARALYSIS

For effective ventilation to occur adequate sedation +/- paralysis is required to prevent

  • Patient discomfort
  • Patient-ventilator dys-synchrony

Patient discomfort

  • Gagging/coughing from the endotracheal tube or resistance to ventilation will increase airway pressure
  • Less sedation is required after prolonged intubation

Patient-ventilator dys-synchrony

  • Spontaneous breaths by the patient may not be co-ordinated with machine breaths
  • Weaning modes such as SIMV help address this problem
  • Deliberate hyperventilation until the ETCO2 falls to 30mmHG can also be used to suppress the stimulus to breathing (but this can also lead to hypotension)

Sedation/Paralysis

  • Sedation can be achieved with midazolam/morphine or propofol 
  • Sedatives can result in low blood pressure if used in large doses
  • Paralysis is usually reserved if there are excessive side effects from sedation (i.e. hypotension)
  • Sedate with propofol 10-20mg/hr +/- 5mg bolus @ 2min prn or morphine/midazolam (1:1) 5-20mg/hr +/- bolus 5mg @ 5min
  • paralyse with vecuronium 8mg loading then 2mg @ 20 min prn
 
Disclaimer: Note: The information described here relates solely to operational matters in the Emergency Department.  Every effort has been made to verify the accuracy of the content. However, neither the author or the hospital will take responsibility for errors resulting from its use.  Please refer to your own departmental guidelines and verify all clinical decisions with a reliable source.  

Date Last Reviewed: 05/08/2004