ICU Sedative Medications
Drug
MO
A
Dose Onset Duration Elimination Positive Considerations Negative
Considerations
Midazolam
(Versed)
GA
BA
erg
ic
1-15
mg/hr
2-5
min (After Bolus)
2-4
hrs
Liver
(Active
metabolite)
Cardio-vascular stability
-No bradycardia
-Little hypotension
Low Cost ($)
Risk if ICU Delirium (all Benzodiazepines)
Accumulation (Lipophilic compound)
Active Metabolite
Lorazepam
(Ativan)
GA
BA
erg
ic
1-15
mg/hr
5-20
min (After Bolus)
4-6
hrs
Liver
(No active
metabolite)
Cardio-vascular stability
-No bradycardia
-Little hypotension
Low Cost ($)
Accumulation (long T )
Consider bolus dosing only
Propylene glycol toxicity
-(High doses, >16 mg/hr X 24 hr)
Propofol
(Diprivan)
GA
BA
erg
ic (?)
15-50 mcg/kg/min
(Avoid doses
greater than 67
mcg/kg/min for
more than 8
hours)
30-90
sec
(Bolus or
Infusion)
Hypotension
common with
bolus dosing!
3-10
min
Liver
(No active
metabolite)
Effective sedative
No risk of accumulation
Easily titratable with no need
to bolus
Hypotension (especial in hypovolemia)
Hypertryglyeridemia (10% lipid emulsion)
-Check serum triglycerides with 48 hrs of
use
Propofol related infusion syndrome (PRIS)
-(60-70 case reports)
-ST elevation in leads V1V3 -Acidosis
-Electrolyte imbalance (K, Mg, Phos)
-Rhabdomyolysis
-CV collapse, High Mortality (>90%)
Dexmedetomidine
(Precidex)
-2
ag
on
ist (pre
syna
ptic)
0.4-1.5
mcg/kg/min
(Bolus dosing
not used in
ICU)
15-30
min
(Infusion)
20-30
min
Liver
(No active
metabolite)
Unique sedative profile
(Arousability maintained)
ICU Delirium
Opioid sparing
No respiratory suppression
(Patient may remain on
after extubation)
Follow U of I MICU dosing guideline
Most common adverse events:
Bradycardia (10% HR)
Hypotension (10% SBP)
Avoid if patient on paralytic/NMBA!!!
Avoid in hemodynamic shock
Duration of use? Safe in large studies
MENDS (7 days) / SEDCOM (14 days)
High Cost ($$$) may decrease total costs
with shorter LOS in ICU and time on vent.
Daily Awakenings and Scheduled Dose-Taper
can minimize accumulation
ICU Analgesic Medications
Drug
MO
A
Dose Equianalgesic
Dose Onset Duration Elimination Positive Considerations Negative
Considerations
Fentanyl
(Drug of choice
for intubated
patients receive
continuous
analgesia)
Op
ioid
25-300
mcg/hr
100 mcg
1-2 min 1-2 hr
Liver
(No active
metabolite)
Short duration of action
Eliminated 1-2 hr after
infusion D/C.ed
Low risk of accumulation
Very potent
Dosing error risk
Respiratory suppression
Airway stability?
Constipation/Ileus
Fentanyl Induced Rigidity
Very rare!
Associated with large
bolus doses
Morphine
Op
ioid
2-30* mg/hr 10 mg 2-8 min 2-6 hr
Liver
(Active
metabolite)
Most clinicians are familiar
with dosing
Longer duration action allows
bolus dosing without
continuous infusion
Histamine release
Flushing
Hypotension
Constipation/Ileus
Hydromorphone
(Dilaudid)
Op
ioid
0.5-10*
mg/hr
(Not commonly
used as
infusion)
1.5 mg
(7-8 fold more
potent than
morphine)
2-8 min 2-4 hr
Liver
(No active
metabolite)
Longer duration action
allows bolus dosing without
continuous infusion
Can be used in renal
dysfunction
No/Less histamine release
Less histamine release
Constipation/Ileus
Date: Feb 2012
