Sedation/Analgesia, PICU, Mechanically Ventilated Patient — Weaning Increments to Reach Conversion Threshold Levels — Clinical Pathway: ICU
Main Pathway
PICU Pathway for Sedation/Analgesia in the Mechanically Ventilated Patient
PICU Sedation/Analgesia Weaning
Patient Likely to be Extubated in the Next 24 Hours
Assess Risk of Withdrawal-associated Adverse Outcomes
If low risk: turn off sedation prior to extubation
Monitor for Signs of Pain, Withdrawal
≥ 5 days of continuous sedation or high risk
Titrate sedation to desired level of wakefulness for extubation
 
Patient
Intubated
(Titrating)
 
Patient Extubated
Wean continuous infusions until conversion
thresholds are met

IV Thresholds for Enteral Conversion

Medication Goal IV Threshold
Fentanyl 2.5 mcg/kg/hr
Morphine 0.1 mg/kg/hr
Hydromorphone 0.015 mg/kg/hr
Midazolam 0.15 mg/kg/hr
NOT Tolerating Enteral Medications
Wean IV Sedation
Tolerating Enteral Medications
Transitioning from IV to PO
Duration 5-9 Days or High Risk < 5 Days
Duration 10-21 Days or High Risk 5-9 Days
Duration > 21 Days or High Risk 10-21 Days
Dexmedetomidine Wean
Opioid Conversion
Benzodiazapine Conversion
Dexmedetomidine Wean
Wean Enteral Sedation
Duration 5-9 Days or High Risk < 5 Days -Enteral
Duration 10-21 Days or High Risk 5-9 Days -Enteral
Duration > 21 Days or High Risk 10-21 Days -Enteral
Monitor Withdrawal Symptoms, (WAT-1 Scale), Pain Scores
Consider Non-Pharmacologic Interventions
Pain Present
Administer opioid or opioid-sparing analgesic as appropriate
WAT Score > 3
Monitor for Over-sedation
  • Contact FLOC if concerned for over-sedation
  • Consider decreasing opioid and/or benzodiazepine doses or skipping a scheduled dose
 
Patient
Extubated
(Weaning)