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