Analgesia-First Sedation in Trauma Patients
Mechanical Ventilation, Respiratory Failure
About this trial
This is an interventional supportive care trial for Mechanical Ventilation focused on measuring Trauma, Analgesia, Sedation, Intubation
Eligibility Criteria
Inclusion Criteria: ≥ 18 years of age Mechanically ventilated with an expected duration of MV ≥ 48h Initiated continuous sedative/analgesic infusions by the ICU team Patient is a candidate for MV weaning Exclusion Criteria: Admission after resuscitation from cardiac arrest Significant neurological deficit due to a chronic disorder History of alcohol dependence and/or other illicit drug abuse Prior administration of continuous sedative/analgesic from a transferring institution Patient receiving neuromuscular blocking agents Allergy to midazolam, lorazepam, and/or propofol
Sites / Locations
- Long Beach Memorial Medical CenterRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Analgesia First Sedation
Protocol Directed Sedation and Daily Sedation Interruption
Subjects will be randomized to receive analgesia-first sedation by intermittent doses of Fentanyl (25 mcg), instead of continuous IV infusions. If the intermittent IVP x4 fails to achieve the target pain score, an infusion starts at 50 mcg/hr and titration by 25 mcg q15 minutes. If sedation score is not achieved, propofol infusion starts at 5 mcg/kg/min to achieve goal RASS of 0 to -2. Subjects will be assessed for a ventilator weaning trial daily.
Subjects will receive Fentanyl for analgesia and midazolam for sedation management. The RASS score is used to guide sedation to a goal of 0 to -2 and daily sedation by IV Midazolam at 1 mg/hr and titrated by 1 mg/hr q60 mins. Midazolam boluses are allowed by 1 mg IVP q5 mins x2 before increasing the infusion rate. Propofol and dexmedetomidine are permitted under existing institutional sedation protocol. Fentanyl IV starts at 50 mcg/hr and is titrated by 25 mcg/hr q15 mins to achieve target pain score. Fentanyl bolus of 25 mcg IVP q5 min x2 doses is given before increasing the infusion rate. Daily sedation interruption (DSI) is performed daily and ventilator weaning trial if they pass.