Bøger af Ahmad Mostafa El-Bkkour

The thought of decreasing or stopping sedatives in critically ill patients who have been agitated may be unsettling. Clinicians may aggressively sedate patients early in their ICU course and then maintain the same level of deep sedation indefinitely. A daily break from sedatives can eliminate the tendency to "lock in" to a high sedative infusion rate that, while appropriate early in ICU care, may be unnecessary on subsequent days. When sedative infusions are decreased or stopped tissue stores can redistribute drug back into the circulation. Interruption of sedative infusions may lead to abrupt awakening and agitation. This must be anticipated by the ICU team to avoid complications such as patient self-extubation. If excessive agitation is noted, sedatives should be resumed . When awakening patients from sedation, for some the ideal may be to reach the brink of consciousness without precipitating excessive agitation. Once objective signs of consciousness are demonstrated, restarting sedatives as needed is reasonable. Restarting the sedative infusion at half of the previous dose also is reasonable. Adjustments from this starting point can be individualized to patient needs