Sedation/Analgesia, PICU, Mechanically Ventilated Patient — SBS > Goal (Under Sedated) and Pain Present — Clinical Pathway: ICU

Sedation/Analgesia, Mechanically Ventilated Patient Clinical Pathway — PICU

SBS > Goal (Under Sedated) and Pain Present

  • Consider opioid PRN
  • Consider initiating adjunctive agents for pain control such as acetaminophen, NSAIDs, or PRN diazepam for muscle spasms if not contraindicated.

SBS > Goal (Under Sedated) and Pain Not Present

Non-pharmacologic Interventions to Assist in Calming Mechanically Ventilated Patients Job Aid

Attempt Non-pharmacologic Interventions

  • Soothing or calming behavior
  • Diaper change
  • Reposition in bed
  • Parental interaction
  • Engage Child Life Therapy

Consider Alternative Causes

  • Confusion – ensure glasses or hearing aids are in place
  • Ventilator dyssynchrony
  • Constipation
  • Urinary retention
  • Pruritus
  • Communication frustration – consider engaging Speech Therapy
  • Severe orotracheal tube discomfort – consider nasotracheal intubation

Pharmacologic Anxiolysis

  • Consider dexmedetomidine or benzodiazepine PRN

Consider Delirium (CAPD > 9)

  • New onset delirium may be an early sign of acute clinical change (e.g., sepsis, neurologic worsening)
  • Attempt to minimize benzodiazepines
    • Consider non-pharmacologic delirium management
    • Optimize sleep hygiene, consider melatonin
  • View the Delirium Clinical Pathway for further guidance.