Sedation/Analgesia, CICU, Mechanically Ventilated Patient — Breakthrough Opioid Dose — Clinical Pathway: ICU

Sedation/Analgesia in Mechanically Ventilated Patient Clinical Pathway — CICU

Breakthrough Opioid Dose for Pain (Pain > 4)

Patients on intermittent morphine or hydromorphone (PO or IV)

  • Give a PRN dosed equivalent to the standing opioid dose (IV or PO).
  • Applies to patients on doses higher than initial starting doses due to opioid tolerance unless the dose is less than an initial starting dose in an opioid-naïve patient, in which case a treatment dose of morphine (per CHOP Formulary) should be administered.

Patients on continuous opioid infusion

  • Give a bolus dose equivalent to the amount of opioids administered over 1 hour.
  • Consider continuing benzodiazepine wean first if a patient is stable and pain is not musculoskeletal in nature.
  • Resume opioid wean when pain is resolved or controlled.