A 72-year-old woman with severe sepsis is intubated. She has been sedated with dexmedetomidine and as-needed opioid boluses. Overnight she becomes bradycardic and hypotensive, requiring the initiation of norepinephrine after fluid boluses fail to correct her hemodynamic derangements. Knowing that she will need to stay intubated for several more days, which of the following is the most reasonable change to make to her comfort regimen?
A. Add propofol with opioids as needed.
B. Initiate a midazolam infusion at 7.5 mg/hr.
C. Start a continuous fentanyl infusion with midazolam boluses as needed.
D. Continue the dexmedetomidine and increase norepinephrine when her pressures drop.
