Sedation Vacation

The two sedatives I have seen used in clinical are propofol and versed. The two times I saw propofol used were for short-term procedures (an ankle reduction and a pediatric liver biopsy). These were not sustained sedations that required sedation vacation. The one patient I worked with that did require sedation vacation was a young woman who was the pedestrian in a pedestrian vs car accident. She had greatly increased ICP and a poor glascow coma scale on arrival. When I worked with her she had been in the PICU for 1 week and was still intubated and being sedated with versed. Sedation was important for her because of her ICP, but they had started weaning protocol and sedation vacation a couple days previous to my shift. Each morning they would reduce the versed drip and turn off the ventilator to assess the patients breathing efforts and neuro function. According to Skyscape, versed used for sedation of intubated and mechanically ventilated patients is dosed 0.02-0.1 mg/kg/hr IV. I didn’t get to witness a sedation vacation, but from talking with the nurse about it a few thoughts come to mind:

The nurse will need to keep the half life of the drug in mind when they begin to titrate            down as some drugs need to be reduced sooner than others (ie versed vs propofol). The nurse should be prepared to titrate throughout the sedation vacation if needed according to response, agitation, etc. Nurse and RT must collaboratively assess respiratory function; RT should measure ABGs. Comfort and ease of breathing should be supported with positioning and medications if possible, such as bronchodilators and/or pain medication.