Lesson 1 of 4
In Progress


Riszel March 9, 2022

Physical Management

  • Securing the endotracheal tube
  • Line suctioning
  • Elevating the head of the bed

Medical Management

  • Pain management (analgesia-first)
  • When pain is fully controlled, post-intubation sedation may be indicated:
  • Agitation
  • Relieve discomfort
  • Improve synchrony with mechanical ventilation
  • Decrease oxygen requirements
  • Decrease overall work of breathing
  • When paralytic use is indicated

Pain Matters

  • Mechanical ventilation for at least 24-hours
  • No sedation vs. propofol/midazolam
  • Bolus doses of morphine (2.5-5 mg) PRN
Outcome No sedation Sedation p-value
Days without mechanical ventilation 13.8 9.6 0.0191
Length of stay 13.1 22.8 0.0316
Mortality 12 22 0.06


  • Mechanical ventilation for at least 24-hours
  • No sedation vs. light sedation (−2 to −3)
  • Morphine for pain management
  • Propofol was used for sedation in the first 48 hours and was replaced by midazolam thereafter
Significant Outcomes Non-Significant Outcomes
Fewer patients without sedation had thromboembolic events •Mortality

•ICU length of stay

•Ventilator-free days

•Delirium/coma-free days

Why Do We Use Sedation in The ICU?

  • Using RASS based assessment and sedation use resulted in reduction in duration of mechanical ventilation