Does anyone follow a certain sedation protocol in their PICU....if so, what sedation scale do you use...
Thanks, Kerry PICU
We have a sedation protocol in place. There is a scale from 1-6, 1 being relatively lighted sedated, infrequent prn doses to a score of 6, meaning continuous infusions of morphine and versed (or ativan or fentanyl) along with a paralytic gtt. We alslo have a sedation wean protocol. As we we wean the gtts, we also start methadone and ativan (each @ q6h - the kids get something every 3).
The sedation levels are specific. If a level is ordered and not met, we (the RN) will adjust the gtts to achieve the stated level. We go up or down by 0.02 if not sedated enough or too sedated. For example, Sedation Score of 3 is patient asleep most of the times, awakens with cares, resettles promptly, does not consistently overbreathe the ventilator. If not sedated enough, bolus 0.1mg/kg q15min. If 4 boluses are given in an hour's time, gtts are increased by 0.02mg/kg/hr until the goal is met. Oversedation goes opposite.
It isn't perfect, but we are doing much better with controlling the withdrawal issues since we instituted the sedation weaning protocols. We try to start the protocol when we believe we are within a couple of days close to extubation.
Last edit by WarEagle4Life on Apr 30, '08
: Reason: wrong dose given