Sedation/Analgesia, PICU, Mechanically Ventilated Patient — Enteral Weaning Plans Greater Than 21 Days (High Risk 10-21 Days) — Clinical Pathway: ICU

Sedation/Analgesia, Mechanically Ventilated Patient Clinical Pathway — PICU

Enteral Weaning Plans

> 21 Days (Consider for High Risk 10-21 Days)

  • Initiate opioid and benzodiazepine weans on consecutive days to allow staggered wean
    • (e.g., wean morphine on day 1 and then wean diazepam on day 2, etc.)
  • Calculate 10% of initial enteral opioid and benzodiazepine doses
  • Wean opioid by the calculated dose every 48 hours
  • Wean benzodiazepine by the calculated dose every 48 hours
  • For patients on an opioid and benzodiazepine, wean every 24 hours in an alternating fashion
  • Once the lowest starting dose is reached, space opioid and benzodiazepine frequencies in a stepwise fashion until off
    • (i.e. q4h → q6h → q8h → q12h → OFF)

Lowest Starting Doses for Enteral Agents

Medication Lowest Starting Enteral Dose
(< 50 kg)		 Lowest Starting Enteral Dose
(≥ 50 kg)
Opioids
Morphine 0.15 mg/kg/dose 7.5 mg
Hydromorphone 0.03 mg/kg/dose 2 mg
Methadone 0.05 mg/kg/dose 2.5 mg
Oxycodone 0.1 mg/kg/dose 5 mg
Benzodiazepines
Diazepam 0. 05 mg/kg/dose 2.5 mg
Lorazepam 0. 05 mg/kg/dose 2.5 mg