Sedation and Ventilation in Critically Ill Patients

A single medication used to calm and reduce anxiety in critically ill patients.

A medication that helps manage mental health conditions but has not been proven effective for preventing or reducing delirium in critically ill patients.

A state of confusion and altered mental state that can occur in critically ill patients.

The use of medications to calm and reduce anxiety, often used to help patients cope with stressful situations in critical care settings.

Critically ill patients are individuals who are very sick and require intensive medical care.

A breathing support technique where a mask is used to deliver pressurized air to the lungs, avoiding a breathing tube.

A medical procedure where a tube is inserted into the trachea to assist breathing.

The process of boosting oxygen levels in the body before intubation.

A situation where the body can't maintain a stable heart rate, blood pressure, and circulation.

Conditions that increase the risk of complications or may prevent effective use of NPPV, but do not completely rule it out.

Pain relief for mechanically ventilated patients.

A scale used to assess a patient's level of agitation or sedation.

A state where a patient is overly agitated and potentially violent, posing a risk to staff.

A state where a patient is very agitated, pulling or removing tubes.

A state where a patient is restless but not aggressive, with frequent, non-purposeful movements.

A state where a patient is awake and calm, with no signs of agitation.

A state where a patient is drowsy but awakens briefly with voice stimulation.

A state where a patient has a light level of sedation but is not fully alert.

A state where a patient is deeply sedated and unresponsive.

A method of non-invasive ventilation that provides continuous positive pressure throughout the respiratory cycle, helping to keep the airway open and improve breathing.

A more advanced form of non-invasive ventilation that uses two levels of pressure: higher pressure during inspiration (IPAP) and lower pressure during expiration (EPAP), mimicking natural breathing.

A decision-making process involving weighing the benefits and risks of intubation (invasive ventilation) against the use of non-invasive ventilation (NPPV).

A medical condition in which patients experience severe breathing difficulties due to an exacerbation of COPD (Chronic Obstructive Pulmonary Disease).

A situation where the heart fails to pump efficiently, causing fluid buildup in the lungs, making it difficult to breathe.

A non-invasive oxygen delivery method that delivers high flow rates of oxygen, exceeding 60 L/min, to patients with respiratory failure.

Patients with reversible respiratory distress, such as COPD exacerbation or Cardiogenic Pulmonary Edema, are more likely to benefit from NPPV.

A failed trial of NPPV can increase mortality, highlighting the importance of careful patient selection for this therapy.

Propofol is a sedative administered as a continuous infusion, starting at low doses and titrated upwards. It effectively reduces the duration of mechanical ventilation. However, it carries the risk of Propofol Infusion Syndrome, a serious and potentially life-threatening condition characterized by metabolic acidosis, rhabdomyolysis, renal and liver damage, and cardiovascular collapse.

Benzodiazepines are a class of drugs that bind to GABA receptors, causing sedation and respiratory depression. They can also enhance the effect of opioids, leading to increased respiratory depression. Benzodiazepines are particularly useful for reducing anxiety and improving ventilator synchrony.

Midazolam and Lorazepam are popular benzodiazepines used for sedation. Midazolam is typically administered as an intravenous push dose of 0.01 to 0.05 mg/kg, while Lorazepam is given in doses of 0.02 to 0.04 mg/kg IV push. The specific doses may vary slightly based on individual patient factors.

Dexmedetomidine, a centrally acting α2-agonist, offers sedation and analgesia with minimal respiratory depression. It is administered as a continuous infusion with a typical dosage range of 0.2 to 1.5 mcg/kg/min. Dexmedetomidine can cause side effects like bradycardia, transient hypertension, and hypotension.

Ketamine is a dissociative anesthetic with moderate analgesic effects and potential benefits in opioid-tolerant patients. It acts on multiple receptor systems, including NMDA, opioid, monoaminergic, muscarinic, and voltage-sensitive calcium ion channels. Ketamine is administered as IV boluses of 1 to 2 mg/kg or as a continuous infusion of 0.5 to 1 mg/kg/h.

Haloperidol and other antipsychotics are adjunctive agents for agitation control in critically ill patients. They are particularly useful in patients who remain agitated despite other sedatives, as they have minimal effects on hemodynamics. Unlike other sedatives, Haloperidol does not have analgesic or amnestic properties.

Clinicians need to choose sedation medications strategically, considering the patient's condition and potential risks/benefits of each drug. Dexmedetomidine, with its potential for reduced sedation-associated delirium and shorter ventilation duration, is gaining prominence. Ketamine and haloperidol are valuable options in specific clinical scenarios.

Ventilator dyssynchrony, also known as patient-ventilator asynchrony, occurs when a patient's respiratory effort does not match the rhythm of the mechanical ventilator. It can be due to factors like weakened muscles, airway resistance, or the patient's inability to coordinate breathing with the ventilator. Dyssynchrony can lead to poor oxygen exchange, increased work of breathing, and complications like lung injury.

The process of adjusting ventilator settings based on patient response and blood gases

A measure of the amount of air breathed in and out of the lungs per minute, influenced by tidal volume and respiratory rate

The volume of air breathed in with each breath

A measure of the pressure required to open the airways during each breath, indicating resistance and lung compliance

A noninvasive method to measure carbon dioxide levels in exhaled breath, often used to assess ventilation and lung function

A measure of the percentage of oxygen in the air delivered to the lungs

The level of oxygen in the blood, indicating how well the lungs are supplying the body with oxygen

A measure of how well HFNC is working, calculated by dividing the ratio of SpO2/Fio2 by the respiratory rate

A mechanical ventilation mode where the ventilator fully controls both breaths and their timing.

A setting on a ventilator that allows air to be kept in the lungs, improving oxygenation and preventing lung collapse

The mode of ventilation where the ventilator delivers a set tidal volume with each breath

The mode of ventilation where the ventilator delivers a set pressure for each breath

A safety measure to prevent overinflation of the lungs by limiting the pressure delivered during each breath

A way to measure oxygen levels in the blood using a sample taken from an artery, often used in critical care settings

A class of drugs that bind to GABA receptors, causing sedation and respiratory depression. They can also enhance the effect of opioids, leading to increased respiratory depression.

A centrally acting α2-agonist that offers sedation and analgesia with minimal respiratory depression. It is administered as a continuous infusion with a typical dosage range of 0.2 to 1.5 mcg/kg/min.

A dissociative anesthetic with moderate analgesic effects and potential benefits in opioid-tolerant patients. It acts on multiple receptor systems, including NMDA, opioid, monoaminergic, muscarinic, and voltage-sensitive calcium ion channels.

Adjunctive agents for agitation control in critically ill patients. They are particularly useful in patients who remain agitated despite other sedatives, as they have minimal effects on hemodynamics.