Sedation/Analgesia, CICU, Mechanically Ventilated Patient — Daily Sedation Interruption — Clinical Pathway: ICU

Sedation/Analgesia in Mechanically Ventilated Patient Clinical Pathway — CICU

Daily Sedation Interruption

Score
  • A time interval in which there is interruption of an intubated patient's sedative and opioid medications to allow patients to "wake up" and reduce the dose of medications by 50%
Purpose
  • Identified as an intervention to reduce mechanical ventilation days and ICU and hospital length of stay
Inclusion Criteria
  • All patients intubated on mechanical ventilation for a minimum of 48 hours up to a maximum of 7 days.
Exclusion Criteria
  • Cardiorespiratory instability in the preceding 24 hours
  • Concern about increased intracranial pressure
  • Significant escalation of sedative medications in the preceding 24 hours
  • Neuromuscular blockade in use
  • End of life care
  • Critical airway
  • Pulmonary hypertension
  • SBS score of +1 or +2
  • Extubated (see Weaning Protocols)
  • Intubated > 7 days (see Weaning Protocols)
Process
  • During morning rounds, discuss if patient is eligible for DSI, and orders will be placed
  • Patient's SBS and Pain Scores will be recorded at least every 60 minutes while infusions are held
  • When patient's SBS is ≥ 0, RN will give a PRN (50% of previous dose) resume sedative and opioid infusions at 50% of original dose
  • RN / FLOC resume treatment according to Sedative / Analgesia Pathway
  • If patient is eligible for DSI and is not done, please document why (attending and RN)
Patient intubated for > 48 hours
SBS -2 or -3
  • Turn off all sedative and analgesics until patient scores
  • an SBS of 0
  • Give PRN (50% previous dose)
  • Resume infusions at 50% previous dose
SBS -1 or 0
  • Decrease PRN (50% previous dose)
  • Decrease infusions by 50%
SBS +1 or +2
  • Follow sedation pathway for SBS > goal