N/IICU Clinical Pathway for Sedation/Analgesia
in the Mechanically Ventilated Infant
N/IICU Pillars of Sedation
- Daily SBS goal
- Use Non-Pharmacological Interventions
- Minimize benzodiazepines and barbiturates
- Administer 1 sedation PRN dose at a time
- Convert to oral sedation when tolerated
Set SBS Goal
Assess and document SBS and Pain with cares min q6hr and PRN
Assess and document SBS and Pain with cares min q6hr and PRN
SBS > Goal
Under-Sedated
Under-Sedated
SBS < Goal
Over-Sedated
Over-Sedated
- Assess SBS and pain q30min
- Consider reversible causes:
- Vent dyssynchrony
- ETT placement appropriate
- Utilize non-pharmacological interventions
- Consider decreasing continuous sedation rate by 20% or by incremental infusion change, whichever is greater.
SBS not at goal 30 min after intervention
First Line Sedation Plan
Intermittent PRN Opioid
Intermittent PRN Opioid
Document SBS and Pain Scores
in EHR 30 min after intervention
in EHR 30 min after intervention
- Goal SBS not achieved at 30 min
- or
- > 3 doses PRN w/in 8 hrs excluding procedural doses
- Consider Opioid Rotation
Document SBS and Pain Scores
in EHR 30 min after intervention
in EHR 30 min after intervention
SBS at Goal
Ready to extubate, wean or convert to enteral sedation
Consult pharmacy for recommendations
Consult pharmacy for recommendations
Evidence
- Sedative and Anticonvulsant Drugs Suppress Postnatal Neurogenesis
- Effects of Morphine Analgesia in Ventilated Preterm Neonates: Primary Outcomes from the NEOPAIN Randomised Trial
- Sedation and Analgesia from Prolonged Pain and Stress During Mechanical Ventilation in Preterm Infants: is Dexmedetomidine an Alternative to Current Practice?
- Dexmedetomidine – An Emerging Option for Sedation in Neonatal Patients
- A Phase II/III, Multicenter, Safety, Efficacy, and Pharmacokinetic Study of Dexmedetomidine in Preterm and Term Neonates
- Dexmedetomidine Versus Standard Therapy with Fentanyl for Sedation in Mechanically Ventilated Premature Neonates