Purpose of Protocol: The purpose of this study will be to compare the clinical utility of
Propofol sedation with and without the use of the ICU Sedation Protocol. Patients will be
treated according to the attending/consulting preference. No attempt will be made to
influence the patient's routine care and management. The study will compare the average
hourly infusion rates for the Propofol administration, as well as obtain the nursing staffs
evaluation regarding the ease of neurological assessment during each 12 hour shift
Study Objectives and Design: Propofol is a short-acting sedative that is easily titratable,
and is approved for use in ventilated patients. The clinical usefulness of continuous
intravenous infusion of Propofol has been demonstrated in the management of ventilated ICU
patients. In addition, its short duration of action permits repeated neurological
assessments to be carried out in patients with neurotrauma.
Despite these benefits, Propofol is not without some drawbacks, including a lack of
analgesic effects, dose dependent lowering of blood pressure, and significant expense. To
address these issues, the PI developed an ICU Sedation Protocol that combines a titrated
continuous infusion of intravenous morphine sulfate with the Propofol infusion to achieve
the desired level of sedation. This ICU Sedation Protocol has been approved for use at
Scottsdale Healthcare since 2004, and printed copies are available at all ICU nursing
stations on the Osborn campus.
At the present time, the ICU Sedation Protocol is used regularly by only two of the five
neurosurgeons that care for the neurotrauma patients at the Osborn campus. The remaining
three neurosurgeons prefer to use a continuous Propofol infusion with intermittent doses of
intravenous morphine sulfate.
The purpose of the study will be to compare the clinical utility of Propofol sedation with
and without the use of the ICU Sedation Protocol. Patients will be treated according to the
attending neurosurgeons preference. No attempt will be made to influence the patient's
routine care and management. The study will compare the average hourly infusion rates for
Propofol administration, as well as evaluating the difficulty of neurological assessment,
and the ease of weaning to extubation.
This is a prospective, non-randomized, open treatment protocol open to ICU patients at
Scottsdale Healthcare Osborn. Only patients with neurotrauma that require intubation will be
eligible for enrollment. Patients will be treated according to the consulting neurosurgeons
preference. No attempt will be made to influence the patient's routine care and management,
as already stated. The choice of sedation type and use of the ICU Sedation Protocol will be
at the consulting neurosurgeons discretion.
Involvement in the protocol will cease when continuous intravenous sedation is discontinued
for more than 24 hours, the patient is extubated or undergoes tracheostomy, or is
transferred from the ICU.
- Ages 18-80 (inclusive)
- Admitted to trauma service
- Intubated and on respiratory support
- Neurosurgical consultation for closed head injury and/or spinal trauma
- Informed consent from next of kin or POA
- Patients less than 18 or more than 80 years of age
- GCS of 3 with bilaterally fixed and dilated pupils
- Penetrating head trauma (e.g., gun shot wounds, nail gun injuries, etc.)
- Pregnant women
- Mentally impaired.