Sedation vacation

I haven’t seen this yet in the hospital but I read the Cottage Hospital Policy on Sunday. Here are some points that I found to be significant and important.

At Cottage Daily Awakening trial (DAT) is performed once daily between 0500-1200.

The goal is for the patient to breath spontaneously once all the sedatives are interrupted. If the patient has met all initial screen criteria RN and RT will assess patient for 2 minutes. Sit up at least 45 degrees, Suction airway, CPAP 5 with 100% tube compression, DO NOT change FiO2. The Nurse is to document sedation level (RASS-Richmond Agitation Sedation Score) and pain score every 30 minutes. Continue for 90 minutes.

Termination Criteria-

• Apnea for 60 seconds in first 2 mins
• Use of accessory muscles, nasal flaring, paradoxical movement of abdomen and ribs
• SpO2<90%
• Severe anxiety, agitation, diaphoresis or decreased LOC
• RR > 28bpm or <6bpm
• SBP >40mmHg over baseline or SBP less than 90mmHg
• HR>25bpm over or under baseline
• New or worsening cardiac arrhythmia.

Evidence based practice states that Daily Sedation Vacation evaluates the need to IV sedation and allows the titration of sedation to reduce the need to mechanically ventilate. This also reduces the time in ICU, ventilator pneumonia and PTSD.

The benefits of Sedation Vacation seem very important for a patient but I’m wondering how often it is truly done and what are the limitations. According to Hogue and Mamula in Nursing Critical Care 2015 nurses understand the importance to evaluate neurological function but agree that documentation of DSV are cumbersome. That’s where education comes in to teach the importance of DSV and what evidence base practice demonstrates. Through education I believe nurses can feel empowered to make a difference and get their ventilator patients put of the ICU and onto recovery.

Hogue, M., & Mamula, S. (2013). Sedation Vacation. Nursing Critical Care, 8, 35-37.

Cottage Hospital Weaning program protocol