Is patient comfortable and at goal? Rule out and correct reversible Causes. Consider Psychiatry Consult Reassess goal dail...
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Analgesia and Sedation Algorithm

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Analgesia and Sedation Algorithm

  1. 1. Is patient comfortable and at goal? Rule out and correct reversible Causes. Consider Psychiatry Consult Reassess goal daily. Titrate to maintain goal Perform daily awakening trial. Consider Psychiatry Consult Is patient in pain? (NRS/BPI) Is patient anxious? (RASS) Is patient delirious? (CAM-ICU) NO YES Set goal for analgesia Set goal for sedation Set goal for delirium control Daily Awakening Trial Stop sedation at 0700. Allow to awaken to RASS><## Alert physician for assessment Restart PRN at 50% prior dose Haloperidol 2-10 mg IVP q 20-30 min, then 25% of loading dose q 6 hrs. **Caution: May cause akathisia (vs. agitation)** Avoid in patients predisposed to QT interval prolongation Ongoing agitation Lorazepam 1-4 mg IVP q10-20 min until at goal/max 15 mg, then q2-5 hr scheduled + PRN OR 1-2 mg q10 min to goal, then continuous inf. at 1-6 mg/hr Ongoing agitation Propofol 5-10 mcg/kg/min titrate by 5-10 mcg/kg/min q5 min to max 50 mcg/kg/min OR Dexmedetomidine 1 mcg/kg IV over 15 min. then 0.2 mcg/kg/hr, titrate to max 2.5 mcg/kg/hr Acute agitation Midazolam 2-5 mg IVP Q5-15 min until acute event controlled/max 20 mg Fentanyl 1-2 mcg/kg IVP q5-15 min or by continuous infusion 0.7-10 mcg/kg/hr OR Hydromorphone 0.5-1 mg IVP q5-15 min OR Morphine 2-5 mg IVP q5-15 min or by continuous infusion 2-5 mg/hr Repeat until pain controlled, then scheduled doses + PRN pain >3 days propofol? Or > 24 hrs Dexmedetomidine? (Rec. max) Convert to benzo- diazepines For Intermittent Dosing If undersedated, rebolus and/or increase dose by 50% or shorten interval between doses. If oversedated, hold until at goal then decrease dose by 50% or lengthen Interval between doses. For Continuous Infusions If undersedated, rebolus and/or increase drip rate by 50%. If oversedated, hold drip until at goal then restart at 50% prior rate or consider intermittent doses. For Patients on Neuromuscular Blockers Never hold sedatives or analgesics until NMB stopped and paralysis is resolved. Critical Care Sedation Guidelines Protocol for Sustained Use of Sedatives and Analgesics in Mechanically Ventilated Adult ICU Patients Modified from 2002 SCCM Sedation and Analgesia guidelines. Crit Care Med . 2002; 30:110-141 Revised 10/07 NRS =Numerical Rating Scale BPI =Behavioral & Psychological Indicators RASS= Richmond Agitation Sedation Scale CAM-ICU =Confusion Assessment Method for the ICU OR For Dexmedetomidine Daily awakening may be contraindicated due to benefit of the drug’s cardiovascular effects Nursing Protocol – Analgesia and Sedation: APPENDIX A

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