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Sedation/Analgesia, CICU, Mechanically Ventilated Patient, Weaning Protocol Clinical Pathway — ICU

Sedation/Analgesia in Mechanically Ventilated Patient Clinical Pathway — CICU

CICU Sedation/Analgesia Weaning

Patient deemed ready for sedation/analgesia weaning

CICU Weaning Principles

Duration of wean should be less than time patient was receiving indicated medication

Enteral therapy should not be initiated until conversion from a continuous infusion is active

Enteral therapy should not be used as an adjunct for high pain/SBS score

Patient received
therapy for ≤ 7 days
Patient received
therapy for > 7 days

If there is concern that patient will go into withdrawl and continuation of sedation,

Wean by 20% of the initial
hourly rate (IHR) every 8-12 hrs until off
See Example

Monitor for signs of Withdrawal
Continue to monitor patient pain and sedation level
If Pain > 4 or WAT > 3, use
Weaning Rescue Dose Guidance or
Breakthrough Opioid Dose for Pain
For patients on both opioid and benzodiazepine infusions, each agent should be weaned in an alternating fashion
Monitor for signs of Withdrawal
Continue to monitor patient pain and sedation level
If Pain > 4 or WAT > 3, use
Weaning Rescue Dose Guidance or
Breakthrough Opioid Dose for Pain
Some patients may be able to have sedation turned
off at provider discretion
Wean sedation/analgesia incrementally until conversion threshold levels are met
See Example
DurationWean Recommendations
8-14 days 10-20% Q 12 hrs
> 14 days 10% Q 12-24 hrs

Conversion Threshold Levels

MedicationGoal IV Threshold
Fentanyl3 mcg/kg/hr
Morphine0.1 mg/kg/hr
Hydromorphone0.01 mg/kg/hr
Midazolam0.15 mg/kg/hr
Convert to Enteral
Sedation Agent
Transitioning from IV to PO
Wait 24 hrs to
assess for signs of withdrawl
Wean Enteral Sedation
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