CICU Clinical Pathway for Sedation/Analgesia
- Related Pathways
Sedation/Analgesia in the CICU
- Exclusion Criteria
- Cessation of neurologic function
- End of life/comfort care
- Neuromuscular blockade infusion
Intubation Likely Required ≤ 24 hrs or Extubated
Intubation Likely Required > 24 hrs
Monitor Patient Response
SBS ≤ Goal
SBS > Goal
Decrease infusion 10–20% if goal maintained > 8 hrs
Medically ready for sedation/analgesia wean
Wean Opioid, Benzodiazepine, Dexmedetomidine IV Infusions to Conversion Threshold
Perform WAT-1 before starting infusion wean
Monitor, Treat Withdrawal Symptoms
Rescue Doses for Withdrawal While Weaning
| IV Thresholds for Enteral Conversion | |
|---|---|
| Dexmedetomidine | 1 mcg/kg/hr |
| Fentanyl | 3 mcg/kg/hr |
| Morphine | 0.1 mg/kg/hr |
| Hydromorphone | 0.015 mg/kg/hr |
| Midazolam | 0.15 mg/kg/hr |
Tolerating Enteral Medications
NOT Tolerating Enteral Medications
Wean infusions off as tolerated
Wean infusions off as tolerated
Monitor, Treat Withdrawal Symptoms
Rescue Doses for Withdrawal While WeaningEnteral Regimen Wean
Opioids, Benzodiazepines, Clonidine
Opioids, Benzodiazepines, Clonidine
Evidence
- Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility
- Evaluation of Institution-Specific Strategy for Converting Dexmedetomidine to Clonidine in a Pediatric Cardiac Intensive Care Unit
- Evaluation of IV to Enteral Benzodiazepine Conversion Calculations in a Pediatric Intensive Care Setting
- State Behavioral Scale (SBS) A Sedation Assessment Instrument for Infants and Young Children Supported on Mechanical Ventilation