ICU Vivas · Sedation & paralysis
Data viva — a sedation, pain and delirium score trend
A data-interpretation viva in which the candidate is given the RASS, CPOT and CAM-ICU trend with the sedative regimen, and must recognise the drift into over-sedation, the under-treated pain, and the emerging delirium, and outline the response.
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CICMFFICMEDIC
Prompt
A three-day trend of the RASS, the CPOT and the CAM-ICU for a ventilated patient, with the sedative regimen, to be interpreted together.
Stimulus
You are shown the three-day trend of a ventilated patient, sedated with a midazolam and fentanyl infusion:
| Day | RASS | CPOT | CAM-ICU | Sedation |
|---|---|---|---|---|
| 1 | −1 | 2 | Negative | Midazolam 4 mg/h, fentanyl 50 microg/h |
| 2 | −3 | 5 | Negative | Midazolam 6 mg/h, fentanyl 50 microg/h |
| 3 | −4 | 5 | Positive | Midazolam 8 mg/h, fentanyl 50 microg/h |
Interpret the trend and outline your response.[3]
References3ShowHide
- [1]Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation/Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS). Critical Care Medicine, 2018.PMID 30113379
- [2]Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. New England Journal of Medicine, 2000.PMID 10816184
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.