What is the role of sedation in mechanical ventilation and how are complications preventions?

Updated: Apr 11, 2019
  • Author: Christopher D Jackson, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

Most patients receiving mechanical ventilation need sedation given by means of continuous infusion or scheduled dosing to help with anxiety and psychological stress inherent with this intervention. Daily interruption of sedation, when clinically allowable, decreases the number of days of mechanical ventilation. This sedation holiday helps the patient become reoriented and prevents the unintended prolonged effects of sedation. Such interruptions also help in assessing the patient for the appropriateness of weaning and hasten the transition to spontaneous respiration. Additionally, it is important to avoid oversedation as it decreases ventilator-free days and increases ICU length of stay.

Studies have demonstrated that protocols driven by respiratory therapy safely decrease the number of ventilator days. These protocols allow the respiratory therapists to begin spontaneous breathing trials (SBTs) when they consider the patient a candidate for weaning.

Elevating the head of the patient's bed by greater than 30° decreases the risk of ventilator-associated pneumonia (VAP). Likewise, rates of VAP can be decreased with implementation of GI prophylaxis with histamine-2 blocking agents or proton-pump inhibitors, as well as deep vein thrombosis prophylaxis. Each of these measures should be undertaken in all patients receiving mechanical ventilation unless a contraindication is present.


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