Sedation/Analgesia, CICU, Mechanically Ventilated Patient — Withdrawl Present — Clinical Pathway: ICU

Sedation/Analgesia in Mechanically Ventilated Patient Clinical Pathway — CICU

Withdrawal Present - Weaning Rescue Dose Guidance

PRN dose equivalent: 50% of standing opioid/benzodiazepine dose)

Presence of Withdrawal Symptoms (WAT > 3)

Always carefully consider other causes.

Step 1

  • Give a PRN dose of agent last weaned equivalent to 50% of the current standing dose (PO or IV).

Step 2

  • If patient remains agitated 30 minutes after the initial rescue dose, administer a second rescue dose of agent (equivalent to 50% of the current PO or IV dosage). Alternatively, if patient is on another opioid or benzodiazepine, consider giving a PRN dose of this agent at 50% of the current standing dose.
  • If more than 3 rescue doses are required in a 24-hour period, devise a new weaning plan with a more gradual tapering. Consult Pain Service or Clinical Pharmacy if patient remains agitated after 3 total rescue doses of either benzodiazepine or opioid.
  • No change in standing current dose of agent.