Sedation is a treatment plan, not a drip. Name the indication, treat pain and reversible distress first, write a target depth, choose the least physiologically disruptive drug, and reassess after every change. Most ventilated CICU patients should be interactive enough for a neurologic exam and liberation work unless a specific indication requires deeper sedation.
Monitoring: ECG, BP cycling, SpO2 plus clinical ventilation observation and waveform capnography during moderate/deep procedural sedation unless precluded or invalidated by patient/procedure factors.
Access: working IV. know concentration and flush dead space.
People: designate a trained observer for monitoring during moderate/deep sedation, separate from the procedural task.
Rescue: pressor, fluids when appropriate, naloxone/flumazenil, defibrillator/pacing ready.
Time-out: indication, dose sequence, target, stop point, and recovery criteria.
Clinical-reference guardrail: follow institutional credentialing, medication concentrations, airway policy, and anesthesia consultation thresholds. The clinician must be able to rescue the patient from a deeper-than-intended state.
Analgesia-first does not mean opioid-first. Separate intensity, mechanism, cause and distress. Treat the cause, then layer nonpharmacologic and local/regional measures with mechanism-specific medication. Reserve the smallest effective opioid or ketamine rescue and reassess function, ventilation, circulation and delirium.
A
Measure, localize and phenotype
pain is a diagnostic signal
1Measure Use patient-reported 0-10 NRS when possible. CPOT or BPS if unable to self-report. Vital signs are cues, not a pain scale.
2Describe Location, quality, trigger, timing, exam, new ischemia or complication, and device/procedure contribution.
3Build Cause control + positioning/local therapy + mechanism-specific nonopioid + proportional rescue.
4Reassess Pain and cough/mobility plus RASS, RR/ETCO2, BP/HR, bowel function and delirium after each change.
B
Phenotype directs the bundle
do not treat every pain alike
Phenotype
Clues
Multimodal path
CICU gate
Somatic / chest wall
Focal, tender, worse with movement or cough. sternotomy, rib, wound
Position/splint, ice or heat. scheduled acetaminophen. topical/local or regional technique. short-acting opioid rescue
Check wound/bleeding. Regional plan must account for infection, coagulopathy and antithrombotic timing.
Visceral / ischemic
Deep, pressure-like or poorly localized. dynamic ECG, perfusion or abdominal findings
Diagnose and treat source first - reperfusion or disease-specific therapy. acetaminophen. titrated opioid only for severe persistent pain
Analgesia must not delay ECG, imaging, drainage or source control. opioid is not anti-ischemic therapy.
Neuropathic
Burning, shooting, electric pain, allodynia, dermatomal or nerve distribution
Conservative start: gabapentin 100-300 mg enterally qHS or pregabalin 25-50 mg q12h. renal-adjust and titrate slowly. topical lidocaine if focal
Not rapid rescue. Gabapentinoids add sedation and respiratory risk with opioids/benzodiazepines.
Inflammatory
Pleuritic, positional, pericardial or musculoskeletal features
Acetaminophen. disease-specific NSAID/colchicine only when indicated. ice/heat and mobilization when appropriate
Do not add NSAIDs routinely in ICU pain. screen AKI/low perfusion, GI bleeding and DAPT/anticoagulation.
Procedure / device
Predictable chest tube, line, dressing, pacing, sheath or repeated bedside care
Preemptive explanation + positioning + local/field/regional anesthesia. small fentanyl or ketamine rescue when needed
Sedation/amnesia are separate. A hypnotic never substitutes for local anesthesia.
Air hunger / dyspnea
Urge to breathe, panic, high drive or ventilator mismatch. may occur without focal pain
Treat hypoxemia, edema, bronchospasm, acidosis and ventilator mechanics. coaching. selected carefully titrated opioid for refractory air hunger
Opioid may ease air hunger, not excessive work. Do not deepen a hypnotic to hide dangerous mechanics.
Tolerance / withdrawal
Verified chronic opioid or MOUD, escalating need, autonomic or GI withdrawal features
Reconcile exposure. continue verified buprenorphine/methadone when feasible. treat withdrawal and acute pain separately. add multimodal therapy. pain/addiction/pharmacy help
Avoid abrupt discontinuation, automatic escalation and reflex reversal unless ventilation requires it.
C
Build complementary layers
one purpose per intervention
NonpharmacologicExplain and coach. position, splint, mobilize, restore sleep. use ice/heat, massage or music when appropriate.
AcetaminophenCommon adult start: 650 mg q6h or 1 g q8h. Count every route/product. IV label max is 4 g/day if ≥50 kg, or 75 mg/kg/day (up to 3.75 g) if <50 kg. Lower the ceiling for liver disease, alcohol use, malnutrition, frailty or severe hypovolemia.
Local / regional1% lidocaine = 10 mg/mL. label ceiling without epinephrine is 4.5 mg/kg (max 300 mg), usually lower in CICU physiology. Track every operator's dose. use trained regional service and LAST rescue.
Neuropathic agentsSchedule, renal-adjust and titrate over days. not PRN rescue. Hold/reduce for somnolence, hypoventilation or encephalopathy.
Ketamine adjunctPADIS postsurgical study regimen: 0.5 mg/kg IV once, then 1-2 mcg/kg/min (very-low-certainty evidence). Bolus may not fit ischemia, tachyarrhythmia or shock. use monitored, validated dosing guidance. See Drug Cards P.4.
Opioid rescueUse small sequential doses to the functional goal. allow onset before redosing. Add ventilation/sedation monitoring and a bowel/withdrawal plan.
Stop gates: new pain can signal ischemia, bleeding, compartment pressure, tamponade, device complication or infection. Do not stack opioid + benzodiazepine + gabapentinoid without a clear indication and enhanced monitoring. “Multimodal” means complementary mechanisms with fewer harms - not simply more drugs.
Do not treat ventilator distress with unconsciousness until you have treated the cause. Fix hypoxemia, tube/circuit problems, flow starvation, auto-PEEP, acidosis, fever and pain. Then use protocolized, goal-directed sedation with daily liberation planning.
A
First hour after intubation
never awake and paralyzed
0-5 min - bridge induction Confirm tube and ventilation, start analgesia, and order the maintenance sedative before the induction agent wears off.
5-15 min - set the goal Record pain score + RASS target. reassess BP/HR, synchrony, pupils/exam, temperature, glucose, bladder and lines.
15-60 min - titrate deliberately Use small changes and allow onset time. Bolus only when urgency justifies the hemodynamic and respiratory hit.
If NMBA was used Ensure continuous analgesia + amnesia while paralysis persists. do not infer comfort from immobility.
B
Choose the maintenance strategy
phenotype, not habit
Need
Usually favors
Why / caution
Fast titration / deeper target
Propofol + opioid
Rapid on/off and anticonvulsant. hypotension, bradycardia, apnea, hypertriglyceridemia and PRIS surveillance.
Light, interactive, extubation-ready
Dexmedetomidine + analgesia
Minimal respiratory depression. bradycardia/hypotension. The 2025 PADIS update conditionally favors dex over propofol when light sedation and/or delirium reduction are highest priorities.
Pain-dominant distress
Fentanyl bolus, then lowest effective infusion
Analgesia-first. reassess before adding hypnotic. Watch apnea, ileus, tolerance and accumulation.
Seizure / alcohol-BZD withdrawal
Midazolam when specifically indicated
Useful for amnesia and anticonvulsant effect. routine infusions accumulate and are associated with slower awakening/delirium burden.
Bronchospasm / opioid-sparing
Ketamine adjunct
Analgesic and bronchodilatory. secretions, emergence, tachycardia and possible hypotension in catechol-depleted shock.
SATReduce/hold sedatives per protocol when no active seizure, paralysis, dangerous agitation, ischemia or other exclusion.
SBTCoordinate awakening with breathing trial. treat pain and anxiety without recreating coma.
If SAT failsName the reason, treat it, restart at a lower dose when possible, and set the next attempt.
DeliriumRestore orientation, sleep cues, hearing/vision and mobility. Screen only when arousable. PADIS 2025 could not recommend for or against antipsychotics as delirium treatment.
Do not chase RASSWhen agitation is caused by hypoxemia, shock, withdrawal, urinary retention, pain or ventilator mechanics.
Evidence nuance: dexmedetomidine and propofol are both reasonable light-sedation agents. MENDS2 found no significant difference in days alive without delirium/coma between dex and propofol in ventilated adults with sepsis. A2B (2025) did not find faster successful extubation with dex or clonidine versus propofol. Both alpha-2 strategies increased severe bradycardia. Choose by physiology.
Titrate to effect, not to the top of a range. The doses below are practical adult starting ranges, not substitute orders. Verify concentration, current labeling, and pharmacy guidance. several ICU adjunct uses are off-label. Reduce and slow in older/frail patients, shock, low cardiac output, organ dysfunction, sleep apnea, obesity hypoventilation and when combining agents.
A
Core agents
start low - wait - reassess
Agent
Practical adult range
Best use
Main hazards / monitoring
Fentanyl
25-50 mcg IV slowly. repeat after effect 25-200 mcg/h infusion
Rapid analgesia. procedures. vent pain. less histamine release
Apnea, rigidity with large/rapid dose, bradycardia, ileus, tolerance. Synergistic respiratory depression with benzodiazepines.
Midazolam
0.5-1 mg IV over ≥2 min. reassess ≥2 min 1-5 mg/h infusion
No analgesia. Apnea/hypotension, delirium and accumulation. reduce with opioids, age/frailty, hepatic/renal dysfunction.
Propofol
Procedure 0.25-0.5 mg/kg or 10-20 mg steps Vent 5-50 mcg/kg/min
Fast deepening/lightening. seizure suppression. frequent exam. brief painful procedures with separate analgesia
No analgesia. Hypotension, bradycardia, apnea. Monitor triglycerides and PRIS. Strict asepsis and product-specific tubing/discard intervals are essential.
Dexmedetomidine
0.2-0.7 mcg/kg/h Avoid loading in most CICU patients
Bradycardia, sinus arrest, hypotension. hypertension with loading. Not reliable for deep hypnosis or paralysis. Reduce in hepatic dysfunction. ICU label limits infusion to 24 h. Longer courses are off-label and need withdrawal surveillance.
Ketamine
Analgesia 0.1-0.3 mg/kg IV Dissociation 1 mg/kg IV, titrate Off-label adjunct 0.05-0.3 mg/kg/h
Painful procedure, bronchospasm, opioid-sparing. dissociation when physiology favors
Secretions, nausea, emergence, nystagmus. HR/BP rise. apnea if rapid. Catechol-depleted shock can still become hypotensive.
Etomidate
Procedure 0.1-0.15 mg/kg IV RSI 0.2-0.3 mg/kg IV
Single, very brief hypnosis when hemodynamic stability matters
No analgesia. Myoclonus, injection pain, apnea. adrenal suppression. Single bolus only - never maintenance infusion.
B
What each drug does not provide
close the missing domain
Hypnosis is not analgesiaPropofol, midazolam and etomidate lack analgesia. Dexmedetomidine has opioid-sparing effects but is insufficient alone for painful procedures.
Analgesia is not amnesiaFentanyl may leave recall. Add appropriate hypnotic/anxiolytic when the procedure requires amnesia.
Immobility is not comfortNeuromuscular blockade provides neither analgesia nor amnesia. Sedate first and continuously.
C
Combination discipline
the interaction is the dose
Combination
Benefit
Bedside rule
Fentanyl + midazolam
Analgesia + anxiolysis/amnesia
Give sequentially, in small doses, with full reassessment between. combination markedly increases apnea and hypotension risk.
Fentanyl + propofol
Pain control + rapid hypnosis
Reduce both doses. propofol bolus is the common hemodynamic pivot.
Ketamine + propofol
Analgesia + hypnosis. may reduce dose of each
Still requires full deep-sedation airway rescue. ketamine does not guarantee spontaneous ventilation.
Dex + opioid
Interactive sedation + analgesia
Watch bradycardia and respiratory depression from the opioid. dex itself does not treat pain reliably.
Never stack before onset. Most avoidable events follow rapid redosing because the first dose was not given time to work. If the patient is too unstable to wait for titration, use an airway-ready deep-sedation plan or proceed with the lifesaving intervention.
Procedural sedation is a continuum. A patient intended for moderate sedation can enter deep sedation or general anesthesia. Preoxygenate, monitor ventilation, assign roles, and be ready to support an airway and blood pressure before the first dose.
A
Before the medication
six-point time-out
1Procedure Pain, duration, immobility and intended depth.
2Patient Airway/OSA, aspiration, allergies, prior anesthesia, organ function.
6Recovery Monitoring, return to baseline, disposition and documentation.
!Local anesthesia Use lidocaine/field block whenever the procedure permits.
!Stop point If airway or hemodynamics worsen, stop drug and rescue first.
B
Synchronized cardioversion
sedate if feasible - never delay rescue shock
Unstable from the rhythm: prepare for immediate synchronized cardioversion. Sedate whenever feasible, but if delay is dangerous, shock first. If synchronization cannot be achieved and the condition is critical, use an unsynchronized high-energy shock per ACLS.
Path
Example start
Best fit / caution
Etomidate
0.1-0.15 mg/kg IV repeat 0.05 mg/kg if needed
Very brief hypnosis with relatively stable BP. no analgesia, myoclonus and adrenal suppression. Airway-ready deep sedation.
Propofol
0.5 mg/kg IV or 10-20 mg steps
Fast onset/recovery in a stable patient. reduce dose and avoid large bolus in shock, severe AS, RV failure or preload dependence.
Fentanyl + midazolam
Fentanyl 25-50 mcg, wait. then midazolam 0.5-1 mg, wait
Slower titration with less predictable recovery. Ensure adequate hypnosis before the painful shock when feasible. Synergistic apnea/hypotension requires airway-ready monitoring.
Ketamine
0.5-1 mg/kg IV, titrate
Dissociative option with analgesia. avoid reflexive use in ischemia/electrical storm or severe tachycardia. Airway events remain possible.
Fentanyl with small midazolam doses or ketamine if physiology fits. do not delay pacing in unstable high-grade block.
Arterial / central line
Positioning + generous local anesthetic
Often no systemic sedation or only cautious anxiolysis. Deep sedation adds risk without improving local anesthesia.
Chest tube / drain
Field block along skin, tract and pleura
Fentanyl plus titrated hypnotic, or ketamine. Sedation never substitutes for pleural/local anesthesia.
TEE / bronchoscopy
Topical anesthesia + secretion/aspiration plan
Moderate/deep sedation by credentialed team. consider anesthesia for difficult airway, severe OSA, tenuous shock or prolonged intervention.
Bedside wound / reduction
Local/regional block when possible
Ketamine, propofol, or fentanyl/midazolam chosen by depth and physiology. continuous ventilation monitoring.
D
Recovery is part of the procedure
do not walk away after the shock
Continue ECG, BP, SpO2 and ventilation observation until airway control, oxygenation, circulation, mental status and protective reflexes return to the planned baseline.
Document drug, dose, time, depth, oxygen/airway interventions, complications, rhythm outcome, pain and disposition.
Watch for resedation, especially after midazolam/opioids or reversal agents.
The induction drug does not fix peri-intubation shock. Optimize oxygenation and circulation, have a vasopressor strategy, dose for the patient's physiology, and start post-intubation analgesia/sedation before awareness returns.
A
RSI sequence for the CICU
the hemodynamic airway
Prepare Expert help, airway plan A/B/C, suction, waveform capnography, defibrillator, difficult-airway equipment, drug labels and post-intubation orders.
Preoxygenate + position Head-elevated when possible. NIV preoxygenation reduces peri-intubation hypoxemia versus an oxygen mask in eligible critically ill adults (PREOXI). Anticipate aspiration risk and intolerance.
Resuscitate Identify RV/LV failure, tamponade, auto-PEEP, vasoplegia and hypovolemia. Start/ready norepinephrine rather than relying on a sedative choice.
Induce + paralyze Give induction agent, then NMBA without delay. Confirm tube with sustained waveform ETCO2.
Immediately after Analgesia + sedative infusion/bolus, ventilator targets, BP/pressor, glucose/temperature, CXR/ultrasound as indicated.
B
Induction agent by phenotype
no drug is shock-proof
Agent
Adult RSI start
Favors
Avoid / anticipate
Etomidate
0.2-0.3 mg/kg IV
Severe LV dysfunction, tenuous BP, very brief induction
Myoclonus, adrenal suppression, no analgesia. Still prepare for post-intubation hypotension.
Ketamine
1-2 mg/kg IV dose-reduce in profound shock
Bronchospasm, pain, selected hypotensive patients
Tachycardia/ischemia, secretions. direct myocardial depression may appear when catecholamine-depleted.
Propofol
0.5-1 mg/kg IV reduced-dose range for vulnerable physiology
Hypertension, seizure, stable circulation
Marked vasodilation/myocardial depression. generally avoid a full bolus in shock, severe RV failure or preload dependence.
Midazolam
Not preferred for routine RSI
Specific seizure/withdrawal context when other agents unsuitable
Slower, less predictable induction and hypotension. accumulated pre-intubation doses complicate awakening.
C
Post-intubation: the forgotten medication emergency
before induction wears off
Analgesia
Fentanyl 25-50 mcg IV and repeat to effect, then intermittent dosing or infusion if ongoing pain. Address tube, lines, procedure and chest discomfort.
Hypnosis
Maintain adequate hypnosis immediately after induction, especially during residual paralysis. Dexmedetomidine alone is not a dependable bridge for deep amnesia. Lighten after blockade resolves and the indication permits.
Target
Write RASS and pain goals. Deeper only for an indication. If paralyzed, use pre-NMBA depth and physiologic/EEG context because RASS cannot be measured.
Ventilator
Set PBW-based tidal volume, appropriate PEEP/FiO2, flow and expiratory time. Sedation cannot repair auto-PEEP or flow starvation.
D
Predict the post-intubation crash
treat before it happens
Mechanism
Clue
Prevention / response
Loss of sympathetic tone
Shock masked by agitation/catecholamines
Pressor running/ready. smaller induction dose. immediate BP cycling or arterial trace.
Loss of preload
RV failure, tamponade, hypovolemia, high PEEP
Optimize phenotype. lowest effective mean airway pressure. urgent disease-specific treatment.
Dynamic hyperinflation
Asthma/COPD, high RR, breath stacking
Low RR, high flow, long expiration. disconnect briefly for extreme auto-PEEP with collapse.
RSI trial (2025): among 2,365 critically ill adults, ketamine did not lower 28-day in-hospital mortality versus etomidate (28.1% vs 29.1%). Cardiovascular collapse during intubation was more frequent with ketamine (22.1% vs 17.0%). Neither agent replaces resuscitation.
The same dose can be gentle in one patient and catastrophic in another. Use the hemodynamic phenotype, needed depth, expected duration and need for neurologic examination to choose the agent.
A
Phenotype-to-agent map
first choice is a reasoning frame
Phenotype / goal
Often useful
Avoid reflexively / bedside nuance
Cardiogenic shock / low EF
Fentanyl in small steps. etomidate for one brief deep event. pressor-supported maintenance plan
Large propofol bolus or dex loading. Any sedative can unmask shock. correct perfusion rather than accepting coma.
RV failure / pulmonary HTN
Minimal effective dose. etomidate for brief hypnosis. preserve oxygenation, ventilation and SVR
Hypotension, hypercapnia, hypoxemia, acidosis and excessive PEEP. Ketamine is not automatically safe if tachycardic/ischemic.
Electrical storm
Deep propofol and/or benzodiazepine-based sympatholysis with airway control. beta-blockade and definitive EP pathway
Undertreated pain/anxiety and sympathomimetic escalation. Sedation is an adjunct and bridge to rhythm stabilization and definitive treatment.
Post-arrest / seizure
Propofol for rapid titration and seizure suppression. benzodiazepine for seizure. EEG-guided depth
Do not confuse drug effect with neurologic prognosis. Reassess after clearance and temperature control.
Bronchospasm
Ketamine for induction/analgesic adjunct. propofol if BP permits
Rapid ketamine can still cause apnea. manage secretions and ventilator expiratory time.
Delirium / weaning
Dexmedetomidine when light, interactive sedation is desired
Routine benzodiazepine escalation. dex may worsen bradycardia or shock.
Neuro exam needed
Short-acting propofol or dex with explicit wake-up plan
Long benzodiazepine infusion and repeated stacking that obscures serial examination.
B
Organ function and patient factors
dose and interval change
Older / frail
Use smaller initial doses, longer waits and less combination therapy. Loss of airway tone and BP can be disproportionate.
Renal dysfunction
Active midazolam metabolites accumulate in renal dysfunction. Opioid clearance varies by drug and exposure. Use clinical wake-up, not the clock, to judge recovery.
Hepatic dysfunction
Reduce midazolam and dexmedetomidine. expect prolonged effect. Encephalopathy is not a reason to ignore pain.
OSA / obesity hypoventilation
Position, preoxygenate, capnography and airway rescue are central. Reduce opioid/benzodiazepine stacking.
Chronic opioid/BZD exposure
Expect tolerance and withdrawal. Reconcile home exposure and build a taper. avoid abrupt reversal unless ventilation demands it.
Pregnancy
Urgency and maternal physiology govern. involve anesthesia/OB for elective deep sedation and agent-specific risk review.
C
When to involve anesthesia early
risk is more than ASA class
Known or predicted difficult airway. prior failed sedation or anesthesia complication.
Severe OSA/obesity hypoventilation, high aspiration risk, inability to lie flat.
Severe aortic stenosis, pulmonary hypertension/RV failure, tamponade or escalating shock.
Need for deep sedation without a secured airway, prolonged TEE/bronchoscopy or painful intervention.
Repeated sedation failure, unusual tolerance, complex withdrawal, or need for general anesthesia.
Procedure location lacks full monitoring, airway rescue or recovery staffing.
New dyssynchronyTube/circuit, pneumothorax, auto-PEEP, edema, secretions, mode/trigger mismatch.
New hypotensionDrug effect may be the clue, not the full diagnosis: bleeding, tamponade, RV failure, sepsis, ischemia.
Practical default: use the least drug that achieves a written goal, but do not undertreat pain, air hunger or a genuinely dangerous indication for deep sedation. Comfort and liberation are simultaneous goals.
Rescue the physiology, not the number. For hypoventilation, open and ventilate the airway. do not wait for SpO2 to fall. For hypotension, stop/slow the drug while treating the hemodynamic phenotype. Reversal agents are adjuncts, not substitutes for BVM ventilation and circulation support.
A
Immediate rescue sequence
call - stop - oxygenate - ventilate - support
1Call for help Stop procedure and sedatives. note last drug/dose/time.
2Airway Position, jaw thrust, suction, oral/nasal adjunct as appropriate.
3Ventilate 100% O2, BVM with ETCO2. intubate if rescue fails or risk persists.
4Circulation BP, rhythm, pulse. fluids if responsive, pressor, atropine/pacing as phenotype requires.
B
Reversal agents
titrate to ventilation, then watch
Agent
Adult bedside start
Use and cautions
Naloxone
0.1-0.2 mg IV q2-3 min to ventilation
Reverse opioid respiratory depression while preserving needed analgesia when possible. Larger doses may precipitate pain, hypertension, pulmonary edema or acute withdrawal. Opioid duration may exceed naloxone - repeat or infuse and monitor for resedation.
Flumazenil
0.2 mg IV over 15 sec. wait 45 sec, then repeat 0.2 mg q60 sec to 1 mg
Selected iatrogenic benzodiazepine oversedation. Avoid in chronic BZD dependence or proconvulsant/mixed overdose. Contraindicated when BZD is controlling a life-threatening condition such as status epilepticus, or in serious cyclic-antidepressant poisoning. Can cause seizures/withdrawal. resedation is common enough to require continued observation.
Stop propofol immediately. supportive care, alternate sedation, consider RRT/ECMO for refractory PRIS.
Dexmedetomidine
New severe bradycardia, sinus pause or hypotension
Stop/slow. remove vagal stimulus. atropine/pressor/pacing as required. Avoid loading dose in tenuous CICU physiology.
Ketamine
Apnea/laryngospasm, severe hypertension/tachycardia, distressing emergence, secretion burden
Airway maneuvers/BVM. stop/reduce. suction. treat physiology rather than assuming dissociation protects airway.
Midazolam/opioid
Slowing respirations, rising ETCO2 with hypoventilation, or loss of waveform with apnea/obstruction. Also hypotension and delayed awakening
Stop drugs, ventilate/support, selective reversal, and continue observation for recurrence.
Etomidate
Myoclonus, apnea, persistent hypotension or repeated-dose temptation
Support airway. reassess diagnosis/volume/pressor. Do not continue as an infusion.
D
Monitoring calendar
close the loop
Frequency
What to document
After every bolus/change
RASS/depth, pain, RR/ETCO2, SpO2, BP/HR, airway support and effect before redosing.
At least each shift
Indication, target, actual depth, delirium screen, cumulative exposure, organ function and line/tube necessity.
Daily
SAT/SBT eligibility, neurologic exam need, mobility, sleep, bowel regimen, withdrawal risk and taper plan.
Propofol ongoing
Trend triglycerides using a validated monitoring plan. check CK/lactate/acid-base and ECG when high-dose/prolonged exposure or PRIS concern.
Oxygen is not ventilation. A disappearing capnogram can reflect apnea, obstruction, disconnection or sampling failure. Check the patient and circuit immediately. ETCO₂ can also fall with low pulmonary blood flow. Original qualitative schematic.