Sedation/Analgesia, Mechanically Ventilated Patient Clinical Pathway — N/IICU

Opioid Rotation

Opioid Rotation may be considered in the following situations:

Total fentanyl infusion dose is ≥ 5 mcg/kg/hr
Total morphine infusion is ≥ 0.15 mg/kg/hr
Rapid escalation in dosing yielding limited clinical response

Converting from a Continuous IV Fentanyl Infusion or IV Morphine Infusion to an Alternative Continuous Opioid

Continuous Opioid Alternative	Conversion Calculations
Fentanyl to Morphine (mg/kg/hr)	Fentanyl ___ mcg/kg/hr x 0.01 = ___ mg/kg/hr IV morphine infusion Example: Fentanyl 4 mcg/kg/hr = 0.04 mg/kg/hr IV morphine infusion
Morphine to Hydromorphone (mg/kg/hr)	Morphine ___ mg/kg/hr x 0.15 = ___ mg/kg/hr IV hydromorphone infusion Example: Morphine 0.12 mg/kg/hr = 0.018 mg/kg/hr IV hydromorphone infusion Hydromorphone minimum incremental infusion titration: 0.002 mg/kg/hr

Continuous Opioid Alternative

Conversion Calculations

Fentanyl to Morphine
(mg/kg/hr)

Fentanyl ___ mcg/kg/hr x 0.01 = ___ mg/kg/hr IV morphine infusion

Example: Fentanyl 4 mcg/kg/hr = 0.04 mg/kg/hr IV morphine infusion

Morphine to Hydromorphone
(mg/kg/hr)

Morphine ___ mg/kg/hr x 0.15 = ___ mg/kg/hr IV hydromorphone infusion

Example: Morphine 0.12 mg/kg/hr = 0.018 mg/kg/hr IV hydromorphone infusion

Hydromorphone minimum incremental infusion titration: 0.002 mg/kg/hr

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.