Acute events overnight

      •   Check vital signs

                  Pulse rate

                  Respiratory rate

                  O₂ saturation

                  Blood pressure

      •   Check fluid balance

      •   Examine chest for

                  Air entry

                  Breath sounds

                  Crackles

                  Wheezing

      •   Check endotracheal tube for

                  Position at mouth/teeth to note significant movement

                  Secretions

      •   Check ventilator screen for

                  PEEP level

                  Peak airway pressure

                  Plateau airway pressure

      •   Check ABG

      •   Check chest x-ray for

                  ET tube position

                  Catheter position

                  Presence of infiltrates

                  Presence of pneumothorax, pneumomediastinum, subcutaneous emphysema

      •   Review sedation management and other medications

                  Assess patient’s comfort

                  Adjust sedation to keep RASS between -1 to -2 (Chapter 18)

                  Discontinue sedation every morning

      •   Review clinical course

                  Current FiO₂

                  Trends in FiO₂

                  Weaning potential

      •   Make therapeutic and diagnostic decisions

                  Reduce PEEP as FiO₂ is reduced.

                  Consider spontaneous breathing trial

      •   Write new orders (consider daily X-ray and ABGs on all ventilated patients)

Study Question

Does over sedation have any important effects on patient outcomes? Explain your answer.

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