Medication Information

What Should I Know About Medications Given in the ICU?

It is important for you to tell the ICU team about all allergies your loved one has. You should also tell us about all medications and nutrition supplements your loved one takes. We can use this information to give patients such as your loved one some of their necessary medications and supplements while they are in the ICU.

It is also important to tell us if your loved one is using nonprescription drugs, alcohol, or both. This information can help us adjust medications in case your loved one goes through withdrawal or if your loved one’s medications do not mix well with the ones we are giving.

Medications and how or when we give them may change while your loved one is in the ICU. Many of the medications we give to patients are based on how sick they are.


This is an IV or catheter placed through the skin into a vein. It helps the ICU team draw blood or give medications.

To receive these medications, your loved one may need to have catheters placed into blood vessels or veins (often called IVs).

We give many types of medications to patients in the ICU. You should speak to our pharmacist, nurse, or doctor about the ones we are giving to your loved one. The following descriptions of medications may help you speak with us (see Table for a summary of these descriptions):

Fluids and Nutrition

Patients in the ICU need fluids and nutrition to help them heal. We may give your loved one fluids with electrolytes through a vein or IV.

In addition to needing fluids and electrolytes, patients need calories, protein, vitamins, and minerals. We may give your loved one this nutrition in the form of food, with the use of a feeding tube, or through a vein or IV.

“Tube feedings” are like protein shakes that athletes drink to have a stronger body. Instead of drinking the nutrition, your loved one will receive it directly into the stomach or gastrointestinal tract. We often do this by inserting a tube into the nose or mouth to reach the stomach or intestine. Sometimes we put a tube through the skin and into the stomach (called a G-tube) or intestine (called a J-tube). We do this with medications that help prevent and control pain (see Analgesics, Sedatives, and Delirium Medications on page 10 for more information about these types of medications).

Nutrition given through a vein is called parenteral nutrition or TPN. We may use TPN depending on your loved one’s condition.

Analgesics, Sedatives, and Delirium Medications

There are many reasons why your loved one may feel uncomfortable in the ICU. The mechanical ventilator (or breathing machine) is a common reason.

In the ICU, we may treat your loved one for pain, anxiety or nervousness, or confusion or delirium. The most common medications we use to help patients feel comfortable are analgesics (often called pain medicines) and sedatives.

  • Analgesics: We may use analgesics to help prevent and control pain your loved one may feel. Examples include acetaminophen (Tylenol), ibuprofen (Advil), morphine, fentanyl, or hydromorphone.
  • Sedatives: We may use sedatives to help prevent anxiety, nervousness, uneasiness, or fear your loved one may feel. Examples include propofol, lorazepam (Ativan), midazolam (Versed), and dexmedetomidine (Precedex).
  • Delirium Medications: We may use delirium medications to help prevent or treat confusion your loved one may develop from being sick and in the ICU. Examples include haloperidol (Haldol), quetiapine (Seroquel), or risperdone (Risperdal).

We will adjust all of these medications to try to keep your loved one calm, comfortable, and somewhat awake when needed.

We may also treat your loved one with continuous sedation. If so, we may interrupt the sedation every day so we can check for changes in your loved one’s behavior and ability to breath without as much support from a ventilator. By interrupting sedation, or giving your loved one a “sedation holiday,” we allow your loved one’s medications to wear off. This prevents the medications from building up. It also lets us check if we can begin removing your loved one from the ventilator. Your loved one may look confused or uncomfortable when woken up, but allowing patients to wake up every day has shown us they are able to get off of the ventilator faster.

Blood Thinners

Patients in the ICU are at risk for having blood clots in the blood vessels of their legs and arms (also called deep vein thrombosis or DVT). We may use blood thinners such as heparin, enoxaparin (Lovenox), or dalteparin (Fragmin) to help prevent these blood clots from forming. These medications may cause your loved one to bruise, especially where we place catheters or IVs. We may also place special squeezing or compression sleeves on your loved one’s legs.

Stomach Acid-Reducing Medications

Patients on a mechanical ventilator are at an increased risk for developing stomach ulcers or stomach bleeding. We may use medications like famotidine, ranitidine, omeprazole, or pantoprazole to decrease how much stomach acid your loved one’s body makes. Patients usually only need these medications while they are in the ICU. Check with your loved one’s primary care doctor if you are not sure whether your loved one should take these medications after leaving the ICU.

Insulin

We often give insulin to patients in the ICU to help control their blood sugar. We may need to do this even if your loved one does not have diabetes or high levels of sugar in the body before being in the ICU. We give insulin as injections under the skin or through a vein. Unless your loved one was on insulin before being in the ICU, most patients do not need to be on insulin once they are better or after they leave the ICU.

Bowel Regimen

Patients may have difficulty having normal bowel movements while they are in the ICU. We may give your loved one medications such as docusate, bisacodyl, and senosides to help keep bowel movements regular.

Pressors

Some patients in the ICU may have too low of a blood pressure and need medications to raise it. These medications are called pressors. We give these medications through a vein and adjust them depending on your loved one’s blood pressure. We can turn them on and off as needed. Examples of these medications include norepinephrine, dopamine, and epinephrine.

Antibiotics

Patients in the ICU on the mechanical ventilator (or breathing machine) may have an infection or are at risk of getting an infection. To treat infection, we choose antibiotics based on the type of infection and the microorganism or “bug” that is or may be causing the infection. If your loved one gets an infection, we will give your loved one antibiotics until the infection is gone. Giving antibiotics for too long may allow the bug to become immune to the antibiotics.

What Is Ventilator-Associated Pneumonia?

Ventilator-associated pneumonia (often called VAP) is an infection of the lung that happens while a patient is on the mechanical ventilator (or breathing machine). If your loved one gets pneumonia, we will treat your loved one with antibiotic therapy. We may also use and adjust other medications to help prevent or treat pneumonia.

How Does the ICU Team Prevent and Treat Pneumonia?

Preventing and, if it occurs, treating pneumonia is important. The Ventilator Bundle is a list of things that we, the ICU team, can do to help prevent and treat pneumonia. The Ventilator Bundle was developed by the Institute for Healthcare Improvement and includes the following actions that we can take:

  • Elevate the head of the bed to keep saliva from going into your loved one's lungs. We will only do this if your loved one's condition allows it.
  • Remove or suction saliva out of your loved one's mouth and clean your loved one's mouth (like brushing your teeth).
  • Allow your loved one to wake up while on the mechanical ventilator (or breathing machine) to check if your loved one can breathe without it.
  • Use medications or place special squeezing or compression sleeves on your loved one's legs to help prevent blood clots in the legs and arms (also called deep vein thrombosis or DVT).
  • Use medications to decrease your loved one's stomach acid, which could cause stomach ulcers or bleeding.

What Is Delirium?

Patients in the ICU on the mechanical ventilator sometimes develop delirium or confusion. This can happen even if they seem to be calm or sleeping.

Delirium is caused by an imbalance in the brain. Some of the signs and symptoms of delirium include confusion, agitation, excessive sleep or lack of sleep, restlessness, and nervousness.

Being sick and in the ICU can cause delirium. The following things can also cause delirium:

  • Being older
  • Having a history of delirium, dementia, or Alzheimer's disease
  • Not being able to see or hear well
  • Infection or severe sickness
  • Electrolyte problems, dehydrations, and malnutrition
  • Problems with the kidneys or liver
  • Recent surgery or trauma
  • Previous alcohol use
  • Pain
  • Sedatives or pain medicines
  • Constipation

How Can I Help the ICU Team Prevent and Treat Delirium?

Families have an important role in helping prevent delirium from occurring in their loved ones and, if it occurs, helping their loved ones get better. The following tips for families will help you be a part of treating your loved one’s delirium:

  • Make sure your loved ones’ hearing aids and eyeglasses are available if they use these.
  • Talk to your loved ones and tell them who you are and that they are safe.
  • Remind your loved ones where they are and tell them the date and time.
  • Tell us, the ICU team, what time your loved ones normally go to bed and what time they get up in the morning.
  • Tell us if your loved ones watch a television show regularly, what music they like to listen to, or other favorites of theirs that would relax and calm them.
  • If your loved ones like reading books, read their favorite books to them.
  • Avoid too much noise or too many visitors.

If you need more information about critical care medications, feel free to ask any member of our ICU team. We want you and your loved one to feel safe and comfortable in the ICU. We have included a list of resources that may also help you understand your loved one’s stay in the ICU.

Glossary

Blood clots: Scabs inside of the body within blood vessels, usually a vein; they are caused by surgery, not being active, catheters, or some types of drugs.

Catheter: A plastic tube that a caregiver puts into a blood vessel to take blood samples, give medications, or measure blood pressure.

Dehydrated: When a body does not have enough water or fluid to work normally.

Delirium: When a person feels confused or sometimes sees things that are not there.

Electrolytes: Chemicals in the body such as sodium, potassium, and calcium.

Hydrated: When a body does have enough water or fluid to work normally.

Immune: When a body builds up strength to prevent and fight infection and repair injury (or when a bug builds up strength to protect itself against antibiotics).

Intravenous or IV: A catheter that is in a vein.

Malnutrition: When a body does not have enough calories or energy to work normally.

Mechanical ventilator: A machine that helps a person breathe when breathing is difficult or impossible.

Nutrition: Calories from sugar, protein, and fat.

Sedation: When a person is not awake or is difficult to wake up.

Withdrawal: When people feel or act sick because they are no longer taking their nonprescription drugs or drinking alcohol.

Table. Descriptions of Medications

 

​Type of Medication ​Examples  ​Reason for Using
Fluids and nutrition ​IV fluid ​Helps keep your loved one hydrated
​Tube feeding or IV nutrition ​Provides your loved one with calories, protein, vitamins, and minerals
​Analgesics (often called pain medicines) ​Morphine  ​Helps prevent and control pain your loved one may feel from sickness, a mechanical ventilator, or catheters
​Fentanyl 
​Hydromorphone 
​Sedatives ​Propofol  ​Helps prevent your loved one from feeling anxiety or uneasiness
​Lorazepam 
​Midazolam 
​Dexmedetomidine 
​Blood thinners ​Heparin ​Helps prevent blood clots from forming in the blood vessels of your loved one's legs and arms (also called deep vein thrombosis or DVT)
​Enoxaparin 
​Dalteparin 
​Stomach-acid medication ​Famotidine  ​Helps prevent stomach ulcers or stomach bleeding
​Ranitidine 
​Omeprazole 
​Pantoprazole 
​Insulin  ​Injection under the skin or given continuously through the vein ​Keeps your loved one's blood sugar in control, even if your loved one has no history of diabetes
​Bowel regimen ​Docusate  ​Keeps your loved one's bowel movements regular
​Senosides 
​Bisacodyl 
​Pressors  ​Norepinephrine  ​Raises your loved one's blood pressure if it is too low
​Dopamine 
​Epinephrine 
​Antibiotics  ​Depends on type and cause of infection ​Helps prevent or treat infections if they occur

 

Resources

Publication Date: 2012
Page Created By: Gail Gesin, PharmD; Eric W. Mueller, BS, PharmD, RPh; Pamela L. Smithburger, BCPS