Sedation/Analgesia, Mechanically Ventilated Patient Clinical Pathway — PICU

Dexmedetomidine Wean

  • Duration < 5 Days
    • Wean dexmedetomidine by 0.2-0.3 mcg/kg/hr every 6 hours
    • Consider dexmedetomidine discontinuation when dexmedetomidine dose is less than 1 mcg/kg/hr
    • Clonidine is not indicated for this patient population
  • Duration 5-9 Days
    • Wean dexmedetomidine by 0.2-0.3 mcg/kg/hr every 12 hours
    • Consider dexmedetomidine discontinuation when dexmedetomidine dose is less than 0.5 mcg/kg/hr
    • Clonidine is not indicated for this patient population
  • Duration 10-21 Days
    • Wean dexmedetomidine by 0.2-0.3 mcg/kg/hr every 24 hours
    • If unable to tolerate dexmedetomidine weans, consider starting clonidine
    • After starting clonidine, may increase frequency of dexmedetomidine weans to every 6 hours if tolerated
    • Consider dexmedetomidine discontinuation when dexmedetomidine dose is less than 0.3 mcg/kg/hr
  • Duration > 21 Days
    • Wean dexmedetomidine by 0.1-0.2 mcg/kg/hr every 24 hours
    • If unable to tolerate dexmedetomidine weans, consider clonidine
    • After starting clonidine, may increase frequency of dexmedetomidine weans to every 12 hours if tolerated
    • Consider dexmedetomidine discontinuation when dexmedetomidine dose is less than or equal to 0.2 mcg/kg/hr
  • Consider Enteral Clonidine
    • Usual starting dose: 0.001-0.002 mg/kg/dose every 6 to 8 hours
    • Max initial dose: 0.2 mg/day
    • Thirty minutes after the 3rd dose of clonidine, continue weaning dexmedetomidine