Sedation/Analgesia in Mechanically Ventilated Patient Clinical Pathway — CICU
Sedation/Analgesia in Mechanically Ventilated Patient Clinical Pathway — CICU
CICU Sedation/Analgesia Weaning
Patient deemed ready for sedation/analgesia weaning
CICU Weaning Principles
Duration of wean should be less than time patient was receiving indicated medication
Enteral therapy should not be initiated until conversion from a continuous infusion is active
Enteral therapy should not be used as an adjunct for high pain/SBS score
Patient received
therapy for ≤ 7 days
therapy for ≤ 7 days
Patient received
therapy for > 7 days
therapy for > 7 days
If there is concern that patient will go into withdrawl and continuation of sedation,
Wean by 20% of the initial
hourly rate (IHR) every 8-12 hrs until off
See Example
Monitor for signs of Withdrawal
Continue to monitor patient pain and sedation level
If Pain > 4 or WAT > 3, use
Weaning Rescue Dose Guidance or
Breakthrough Opioid Dose for Pain
Continue to monitor patient pain and sedation level
If Pain > 4 or WAT > 3, use
Weaning Rescue Dose Guidance or
Breakthrough Opioid Dose for Pain
For patients on both opioid and benzodiazepine infusions, each agent should be weaned in an alternating fashion
Monitor for signs of Withdrawal
Continue to monitor patient pain and sedation level
If Pain > 4 or WAT > 3, use
Weaning Rescue Dose Guidance or
Breakthrough Opioid Dose for Pain
Continue to monitor patient pain and sedation level
If Pain > 4 or WAT > 3, use
Weaning Rescue Dose Guidance or
Breakthrough Opioid Dose for Pain
Some patients may be able to have sedation turned
off at provider discretion
off at provider discretion
Wean sedation/analgesia incrementally until conversion threshold levels are met
See Example
See Example
Duration | Wean Recommendations |
---|---|
8-14 days | 10-20% Q 12 hrs |
> 14 days | 10% Q 12-24 hrs |
Conversion Threshold Levels
Medication | Goal IV Threshold |
---|---|
Fentanyl | 3 mcg/kg/hr |
Morphine | 0.1 mg/kg/hr |
Hydromorphone | 0.01 mg/kg/hr |
Midazolam | 0.15 mg/kg/hr |
Wait 24 hrs to
assess for signs of withdrawl
assess for signs of withdrawl
Wean Enteral Sedation