Discover more from Holding the Line with Dr. Funtimes
Critical care protocols from the University of Utah department of critical care. What they did to people in 2020.
This document is a tragic read. I spent 7 years in the ICU environment and we intubated a lot of people. Managed ventilated patients every single day. We were a 14 bed ICU, one of 9 ICU’s in the hospital I worked for. There are plenty of things in this that do not add up.
Some people freak out when they see that Fentanyl and Propofol and Ketamine are used. This actually normal. We have historically had infusions of Fentanyl and Propofol running at the lowest dose possible to keep a patient comfortable and not fighting the vent, but not at high doses. Common combinations when I worked in the ICU was Fentanyl running at 25mcg/hour and Propofol at 20-30/hour. Or we would sub out Propofol and run 1-2mg Midazolam per hour. So these induction numbers for Midazolam are high and concerning. 6-10mg induction? They are already paralyzed and sedated with the etomidate and the succ, and the ketamine running at a high dose…..that amount of midazolam is not needed for induction (or maybe even needed period).
Then there is this. None of these criteria would indicate a need to intubate. But notice that ** at the top. *DECISION TO INTUBATE IS THE DESCRETION OF THE PROVIDER**. Were patients intubated that did not need to be??? We have heard that many were. The decision to intubate isn’t a provider decision, it is a medical decision based on labs, patient presentation, etc.
This is an interesting 29 page read.