Sedation Vacay

I had never encountered the term sedation vacation before my time in the SICU last week. My nurse did bring up the term in educating me and said that it is used on critical patients such as the patient with a TBI I had on Thursday who was on long-term heavy sedation with Versed, Fentanyl, and Propofol, while intubated in the ICU to give her various body systems a break from the physiological effects of the sedatives. It also allows the nurse to perform a neurovascular check, as well as reducing the risk of ventilator acquired pneumonia and ICU delirium as well as assessing the patient’s readiness to extubate, which is the ultimate goal. I asked my nurse if, when they were given the sedation vacation, they were disturbed by the ventilator.

 

I imagined that if I were awakened suddenly out of a foggy sedation and found myself on a ventilator, I would be very disturbed. The nurse assured me that the patients were not fully awakened and so that was not a problem.

 

My nurse explained that ideally the sedation vacation is performed by a multidisciplinary team consisting usually of the nursing, respiratory, pharmacy, and the primary intensive care unit team. It is ideally done daily or once a shift. It can only be performed on patients who are hemodynamically stable enough to tolerate the vacation. These patients must also not show agitation, be properly oxygenated, not have very much secretions, and normal respirations under 38 per minute (ICU Sedation Guidelines of Care).

Patients are assessed for spontaneous breathing The Ramsey Scale which identifies six levels of sedation from severe agitation to deep coma is used. The Richmond Agitation and Sedation Scale is also used. It measures from light sedation to unarousable (ICU Sedation Guidelines of Care).

Sedation vacations, or daily sedation cessation trials have been found to reduce overall time on the ventilator, needed fewer diagnostic tests to examine neurologic function, had a better psychological adjustment and fewer instances of PTSD six months after their ICU stay (Dunn & Baker, 2011).

 

 

Dunn, J. & Baker, M.W. (2011). Daily Sedation Breaks and Breathing Trials Help

Wean Patients from Ventilators Safely. American Nurse Today 6(3). Retrieved from http://www.medscape.com/viewarticle/741046

 

ICU Sedation Guidelines of Care. (2009). Retrieved from

http://www.carefusion.com/pdf/The_Center/2009-ICU-sedation-toolkit-disclaimer-updated-may-30-2014.pdf