PICU Sedation/Analgesia Weaning
Patient Likely to be Extubated in the Next 24 Hours
If low risk: turn off sedation prior to extubation
Monitor for Signs of Pain, Withdrawal
Monitor for Signs of Pain, Withdrawal
≥ 5 days of continuous sedation or high risk
Titrate sedation to desired level of wakefulness for extubation
Patient
Intubated
(Titrating)
Intubated
(Titrating)
Patient Extubated
Wean continuous infusions until conversion
thresholds are met
thresholds are met
IV Thresholds for Enteral Conversion
Medication | Goal IV Threshold |
---|---|
Fentanyl | 2.5 mcg/kg/hr |
Morphine | 0.1 mg/kg/hr |
Hydromorphone | 0.015 mg/kg/hr |
Midazolam | 0.15 mg/kg/hr |
NOT Tolerating Enteral Medications
Wean IV Sedation
Wean IV Sedation
Duration 5-9 Days or High Risk < 5 Days
Duration 10-21 Days or High Risk 5-9 Days
Duration > 21 Days or High Risk 10-21 Days
Duration 10-21 Days or High Risk 5-9 Days
Duration > 21 Days or High Risk 10-21 Days
Wean Enteral Sedation
Duration 5-9 Days or High Risk < 5 Days -Enteral
Duration 10-21 Days or High Risk 5-9 Days -Enteral
Duration > 21 Days or High Risk 10-21 Days -Enteral
Duration 10-21 Days or High Risk 5-9 Days -Enteral
Duration > 21 Days or High Risk 10-21 Days -Enteral
Pain Present
Administer opioid or opioid-sparing analgesic as appropriate
Monitor for Over-sedation
- Contact FLOC if concerned for over-sedation
- Consider decreasing opioid and/or benzodiazepine doses or skipping a scheduled dose
Patient
Extubated
(Weaning)
Extubated
(Weaning)