pharm management of mechanical ventilation

Question 1

if sedation is needed…

Answer 1

use the lowest dose needed

Question 2

analgesics should be considered first like…

Answer 2

Fentanyl
Morphine
Dilaudid

Question 3

describe propofol

Answer 3

Anesthetic agent, lipid based, short-acting
Causes global CNS depression through agonism of GABAA receptors
Continuous IV infusion
Main side effect: Hypotension, extravasation
Change tubing/bottle every 12 hours
Contraindicated with egg, soybean or peanut allergy
Rare complication: Propofol Infusion Syndrome, Pancreatitis

Question 4

describe dexmedetomidine HCI

Answer 4

Alpha-2 adrenergic agonist, sedative
Acts on alpha2a receptors in brainstem to inhibit norepinephrine release
Continuous IV infusion
Bradycardia and hypotension may occur
Titrate no more frequently than q 30 min

Question 5

describe benzos

Answer 5

Anxiolytics
Activate GABAA neuronal receptors in the brain
Indicated for alcohol withdrawal or when propofol or dexmedetomidine are unavailable or contraindicated
May precipitate delirium, prolonged ventilation and increased ICU length of stay
Reversal agent = Flumazenil/Romazicon

Question 6

describe NMBAs

Answer 6

Used to decrease oxygen demand in the severely compromised patient (ARDS)
May also be used for post-op patients with open incisions or with patients receiving therapeutic hypothermia
Cisatracurium (Nimbex), Rocuronium, Vecuronium (Norcuron) Atracurium (Tracrium)
Need sedation and pain control!
BIS Monitor & Train of Four Monitor

Question 7

what do you use prior to starting NMBA

Answer 7

Peripheral Nerve StimulatorTrain of Four

Question 8

nursing considerations for NMBAs

Answer 8

Safety: Advanced airway in place and secure
Safety: Ambu bag/mask/airway at bedside
Infuse med only after patient adequately sedated
Eye care
Skin care
Once NMBA discontinued, continue sedation until TOF 4/4