Sepsis — Intubation/Sedation Medications — Clinical Pathway: Emergency Department, Inpatient and PICU

Sepsis Clinical Pathway — Emergency Department, Inpatient and PICU

Intubation/Sedation Medications

  Drug Dose Comment
Sedation Fentanyl 2 mcg/kg dose IV
(max 100 mcg/dose)		 Consider administration over 3-5 minutes to avoid chest wall rigidity
Ketamine 0.5-2 mg/kg/dose IV May start with smaller doses when needed (e.g., patients with cardiac dysfunction)
Use with caution in catecholamine refractory patients as may cause hypotension
May cause increased secretions, consider using with glycopyrrolate (see below)
Midazolam 0.05 mg/kg/dose IV May use as adjuvant for sedation with above medications
Use with caution in hypotensive patients
Neuromuscular Blockade Rocuronium 1.2 mg/kg/dose IV
(max 120 mg/dose)		 To be given once patient is adequately sedated (if not rapid-sequence intubation)
For alternative agents to achieve neuromuscular blockade, please see Formulary
Adjuvants Atropine 0.02 mg/kg IV For bradycardia or control of secretions with ketamine induction
Glycopyrrolate 5 mcg/kg IV
(max 200 mcg/dose)		 For bradycardia or control secretions with ketamine induction

For ongoing sedation needs, use the PICU Sedation Pathway

Note

Etomidate is NOT recommended due to concern for adrenal suppression, possible association with mortality.
If patient is intubated and sedated for more than several hours, consider continuous sedation.
For patients with persistent shock and hypoxemia, consider continuous neuromuscular blockade to decrease oxygen demand.