Management

Physical Management

• Securing the endotracheal tube
• Line suctioning
• Elevating the head of the bed

Medical Management

• Pain management (analgesia-first)
• When pain is fully controlled, post-intubation sedation may be indicated:
• Agitation
• Relieve discomfort
• Improve synchrony with mechanical ventilation
• Decrease oxygen requirements
• Decrease overall work of breathing
• When paralytic use is indicated

Pain Matters

• Mechanical ventilation for at least 24-hours
• No sedation vs. propofol/midazolam
• Bolus doses of morphine (2.5-5 mg) PRN

NONSEDA Study

• Mechanical ventilation for at least 24-hours
• No sedation vs. light sedation (−2 to −3)
• Morphine for pain management
• Propofol was used for sedation in the first 48 hours and was replaced by midazolam thereafter

Why Do We Use Sedation in The ICU?

• Using RASS based assessment and sedation use resulted in reduction in duration of mechanical ventilation