Today’s pearl provides some advice on how to properly increase sedative rates for intubated patients
Why do boluses matter?
As we manage more critically-ill, mechanically ventilated patients in the ED, there is an important pharmacokinetic principle that bears mentioning: When increasing the rate on an opioid or benzodiazepine infusion, it MUST be simultaneously paired with a bolus.
Example: Patient receiving fentanyl 50 mcg/hr. If we simply increase the rate to 100 mcg/hr, it will take a full hour to receive the additional 50 mcg (and several hrs to reach a new steady-state). This will not help us right now, which is why we need the additional bolus. The bolus is generally 25-50% of the new rate. In this example, 25-50 mcg would be appropriate.
This can be accomplished in two ways in your electronic medical record (i.e., Epic):
1. Choose the bolus from infusion option when ordering which allows nurses to document the additional dose(s)
2. Add a separate prn order for the boluses