ICU Advantage Video Lesson: Sedation

Introduction

• Presenter: Eddie Watson
• Channel: ICU Advantage
• Topic: Sedation in ICU Drips
• Part 1 of 2 lessons on sedation

What is Sedation?

• Critical care patients often experience discomfort and anxiety.
• Primary Step: Ensure pain relief first with analgesia.
• Sedatives:
  • Reduce anxiety
  • Reduce awareness to noxious stimuli
  • Induce sleep
• Important: Sedatives do not address pain.
• Use: Ensure tolerance to interventions, promote clinical stability, protect from self-harm.
• Caution: Can negatively affect outcomes or increase delirium risk. Aim to minimize use.

Reasons for Using Sedation

1. Amnesia
   • Useful for procedures, surgeries, or interventions.
   • Not recommended as a sole reason except with paralytics.
2. Ventilator Tolerance
   • Addresses ineffective, dyssynchronous, or excessive respiratory effort.
   • Increase in work of breathing and O2 consumption.
   • Use sedation if needed, in boluses or continuous IV.
3. Anxiety and Fear
   • Difficult to assess in critically ill patients.
   • Signs: distress, agitation, thrashing, diaphoresis, elevated BP/HR.
   • Oral anxiolytics preferred but sedation sometimes necessary.
4. Patient Safety and Agitation
   • Manage harmful behaviors: thrashing, removing lines/tubes, etc.
   • Sedation prevents/reduces agitation, enhancing safety.
5. Sleep Deprivation
   • Common in critically ill with pain, discomfort, anxiety.
   • Non-pharmacological interventions preferred before sedation.
6. Delirium
   • Occurs in 50-80% of critically ill patients.
   • Long-term cognitive effects; vast majority are hypoactive or mixed.
   • Routine assessment crucial.
   • Avoid sedatives for delirium as it may worsen condition.

Goals for Monitoring Sedation

• Use appropriate drug and dose for positive outcomes.
• Avoid drowsiness and respiratory depression.
• Maintain calm, awake, or easily arousable state.
• Utilize a sedation scale for appropriate dosing.

Richmond Agitation Sedation Scale (RASS)

• Scale Range: -5 to 4
• Goal: Usually 0 or -1
• Scale Levels:
  • -5: Unresponsive
  • -4: Deep Sedation
  • -3: Moderate Sedation (no eye contact)
  • -2: Light Sedation (brief eye contact)
  • -1: Drowsy (more than 10 seconds awake)
  • 0: Alert and Calm
  • 1: Restless (anxious, not aggressive)
  • 2: Agitated (non-purposeful movements)
  • 3: Very Agitated (aggressive behavior)
  • 4: Combative (immediate danger)

Conclusion

• Discussed sedation uses, monitoring, and assessment.
• Importance of monitoring using RASS for appropriate sedation.
• Upcoming lesson will cover medications for sedation.
• Encouragement to support the channel and stay tuned for part two.