The summer edition of the North Eastern Ohio Critical Care Society (NEOCCS) was held at Johnny’s Downtown in Cleveland, OH. The event was sponsored by Hospira. The meetings featured Intensivists-Anesthesiologists, Critical Care Fellows, Residents and an ICU Nurse Practitioner.  The discussion was related to sedation in the ICU and specifically addressed the “almost impossible” to sedate post op patient at risk for respiratory collapse. Dr. Ali Jahan (CCF) was the presenter for the evening. He moderated a heated debate upon the use of several different pharmacological agents (such as haldol, propofol, benzodazepines, narcotics, dexemetetomidine) as well as ventilation techniques (NIPPV vs. intubation) in such a patient. There were some strong opinions in favor of particular medicines. Bottom line – no one really opted to use benzos in high doses or narcotics in high doses. The decision was split amongst practitioners regarding the use of high dose haldol vs. propofol vs. dex +/- low dose haldol.  Obviously, the greatest advantage of propofol and dex over haldol is the ability to titrate to effect and rapid elimination! Dex’s great advantage over propofol being that the respiratory mechanics of the patient and the ventilatory drive are not depressed, which can be very important in the ICU setting since intubation can be avoided. After significant deliberation and hearing several success stories regarding the different therapies, I guess the “magic bullet” is yet to be found. It all must depend on the practitioner and his/her level of comfort with the drug whether it be haldol, propofol or precedex. However, Precedex does offer some level of safety and clinical advantage over the other two in specific situations.

The summer session concluded – an excellent review, a fun crowd and a thought provokingsession. Stay tuned to the blog for a copy of the actual *.ppt presentation from the meeting.