ICU Pathway for the Evaluation/Treatment of Infants > 28 Days and Children with Severe Sepsis/Septic Shock

Intubation/Sedation

  Drug Dose Comment
Sedation
Fentanyl
Ketamine
Midazolam
2 mcg/kg dose IV
(max 100 mcg/dose)
0.5-2 mg/kg/dose IV
0.05 mg/kg/dose IV
Administer over 3-5 minutes to avoid chest wall rigidity
May start with smaller doses when needed (i.e., patients with cardiac dysfunction)
Use with caution in catecholamine refractory patients as may cause hypotension
May cause increased secretions, consider using with glycopyrrolate (see below)
May use as adjuvant for sedation with above medications
Use with caution in hypotensive patients
Neuromuscular Blockade Rocuronium 1.2 mg/kg/dose IV
(max 120 mg/dose)
To be given once patient is adequately sedated (if not rapid-sequence intubation)
For alternative agents to achieve neuromuscular blockade, please see Formulary
Adjuvants
Atropine
Glycopyrrolate
0.02 mg/kg IV
(minimum dose 0.1 mg)
4-10 mcg/kg IV
(max 0.2 mg/dose)
For bradycardia or control of secretions with ketamine induction
For bradycardia or control secretions with ketamine induction

Note:

Etomidate is NOT recommended due to concern for adrenal suppression, possible association with mortality.
If patient is intubated and sedated for more than several hours, consider continuous sedation.
For patients with persistent shock and hypoxemia, consider continuous NMB to decrease oxygen demand.