CICU Pathway for Sedation/Analgesia in the Mechanically Ventilated Patient

Neonatal Protocol

Medication Infusion Fentanyl
Incremental Infusion Change
Fentanyl 0.5 mcg/kg/hr (e.g. increase from 1.0 to 1.5 mcg/kg/hr)
Assess / Titration Use SBS and pain scores (FLACC)
Assess both every 4 hrs, at minimum
Assess 10 minutes after PRN doses, and infusion changes
PRN Doses PRN Fentanyl dose matches hourly infusion rate when patient receiving infusion
RN may administer 2 PRN doses based on SBS
If a second PRN dose is required, RN contacts FLOC for incremental change in OR initiation of infusion
Contact FLOC to discuss increase infusion rate if 3 or more PRNs (dose equivalent to hourly infusion rate) are administered in 6 hours
Neonatal Protocol
Age < 30 Days
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Fentanyl Infusion +/- Bolus
Begin infusion if clinically indicated / stable, at the discretion of FLOC
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Assess SBS, Pain Score
every 4 hours and PRN
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SBS < Goal
Contact FLOC
Consider decrease
infusion rate
SBS at Goal
SBS Above Goal
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Pain Score ≥ 4
Pain Score < 4
1st PRN fentanyl
Reassess in 10 minutes
1st PRN fentanyl
Reassess in 10 minutes
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Pain Score ≥ 4
SBS not at Goal
2nd PRN fentanyl
Reassess in 10 minutes
2nd PRN fentanyl
Reassess in 10 minutes
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Contact FLOC to consider:
Increase infusion + PRN doses
Initiate infusion if not currently receiving
If at any point there is concern for inadequate analgesia please discuss with FLOC

Pain Scales

FLACC Term NB – 7 yrs
FACES ≥ 3 yrs, able to self-report
Numeric Rating Scale > 5 years
SBS
Pediatric patients on mechanical ventilation
Response to stimuli, 6 point scale