Harris Regional ICU Daily Sedation Vacation Guidelines

1. Does the patient have any contraindications to awakening?

a. Seizures
b. Alcohol withdrawal
c. Paralytics
d. Myocardial ischemia within 24 hours
e. Elevated intracranial pressure
f. Life support withdrawal
g. Physician order to withhold daily sedation vacation
2. Procedure for daily vacation from Propofol:
a. Manage pain. Use FLACC or most appropriate form of pain assessment. Provide pain
medication/intervention as appropriate.
b. Reduce Propofol rate in half.
c. If after 30 minutes patient is still not overly agitated or delirious stop the Propofol drip.
d. If patient becomes agitated or delirious after reducing the drip in half:
i. Increase by 5 mcg/kg/min every 5 minutes to goal level of sedation (standard
titration parameter) up to pre-specified maximum dose.
e. If patient becomes agitated or delirious after stopping the drip:
i. Restart drip at 5 mcg/kg/min, increase by 5 mcg/kg/min every 5 minutes to goal
level of sedation (standard titration parameter).
3. Procedure for daily vacation from Lorazepam or Midazolam:
a. Manage pain. Use FLACC or most appropriate form of pain assessment. Provide pain
medication/intervention as appropriate.
b. Stop Lorazepam or Midazolam drip.
c. If patient becomes agitated or delirious:
i. Begin drip at half the most recent rate then:
1. Lorazepam: increase by 1 mg every 30 minutes to sedation
goal(standard titration parameter) up to pre-specified maximum dose.
2. Midazolam: increase by 1 mg every 15 minutes to sedation goal
(standard titration parameter) up to pre-specified maximum dose.
4. If at any point the patient’s sedation or pain level cannot be adequately maintained with the
current orders, contact the physician.

References: Kress JP, Pohlman AS, O’Connor ME, et al. Daily interruption of sedative infusions in critically ill
patients undergoing mechanical ventilation. N Engl J Med 2000; 342: 1471-1477

www.delirium.org/docs/WakeUpandBreathe.pdf