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(^) Figure 3.PICU (^) LONG TERM EXTUBATION ALGORITHM (>3 days or chemically
paralyzed )
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AND
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Morphine 0.05 mg/kg/hr IV to maintain comfort
Exhibiting signs of agitation requiring rescue boluses
3 non procedural boluses in 8hrsSBS greater than target or
Midazolam 0.05 mg/kg/dose IVq1h prn
Exhibiting signs of discomfort requiring rescue boluses
Morphine 0.05 mg/kg/dose IV q1h prn
to reduce physiologic stress and anxietyMidazolam 0.05 mg/kg/hr IV^
Increase infusion of narcotic or benzodiazepine by 10%
3 non procedural bolusesor SBS > target
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Increase other infusion by 10%^
Consider clonidine patch or ketamine infusion (15-40mcg/kg/min)
if continuing to escalate on infusiowithout adequate sedation ns
Repeat if >3 non procedural boluses in 8hrs or SBS > target