Collaborative Care with RT

In clinical, what are you seeing related to sedation vacation and collaboration with Respiratory Therapists? What is ideal? What is standard practice? What medications are you seeing in the clinical setting for sedation? What tools are used to determine the infusion rate?

In clinical the main areas I have witnessed collaboration with Respiratory Therapists (RTs) is my time in NICU, PICU, or when my patient in Med/Surg went into respiratory distress and we had to call rapid response. In the NICU, the RTs play a crucial role monitoring all of the neonates on vents and making changes as needed.

I haven’t witnessed sedation vacations on the floor, but it seems like a good concept to implement. When a patient is on a mechanical ventilator it can be uncomfortable and inadvertently inflict pain on the patient. Sedation is provided to give the individual a more pleasurable experience amongst the necessary equipment to monitor their well-being. The ideal practice is to provide a vacation or weaning from the sedation medications once a shift to assess neurological systems, ability to follow commands, and evaluate the need for remaining on sedation.

In the clinical setting the medications that I have most seen used are fentanyl and lorazepam.

To determine the infusion rate:

drug dose ordered (mcg) x patient’s weight (kg) x 60
drug concentration (mcg/mL)

You also want to know the target goal for sedation, times of sedation vacations, and how often neurological checks are to be performed.

Hogue, M., & Mamula, S. (2013). Sedation vacation: Worth the trip. Nursing 2015 Critical Care, 8(1), 35-37.