鎮静・鎮痛 (ICU)
<鎮痛>
Mild pain (pain score 1-3)
- Fentanyl 25mcg IV q2h prn
- Hydromorphone 0.25mg IV q4h prn
- Morphine 2mg IV q2h prn
- Ketorolac 15mg IV q6h prn
Moderate pain (pain score 4-6)
- Fentanyl 50mcg IV q2h prn
- Hydromorphone 0.5mg IV q4h prn
- Morphine 4mg IV q2h prn
- Ketorolac 15mg IV q6h sch
Severe pain (pain score 7-10)
- Fentanyl 75mcg IV q2h prn
- Hydromorphone 1mg IV q4h prn
- Morphine 6mg IV q2h prn
[Continuous infusion for analgesia]
Fentanyl 2500mcg/NS 200ml
Start at 25 mcg/hr; titrate by 10 mcg/hr q5 min to PAIN Score 3/10; or to GOAL RASS Score 0 to -1; to a maximum of 200 mcg/hr
(Adjust in opioid tolerant patients. No max when used for comfort measures)
Morphine 100mg/NS 90ml
Start at 1 mg/hr; titrate by 1mg/hr q5min to PAIN Score 3/10; or to GOAL RASS Score 0 to -1; to a maximum of 20 mg/hr.
(Adjust in opioid tolerant patients. No max when used for comfort measures)
Hydromorphone 50mg/NS 50ml
Start at 0.2 mg/hr; titrate by 0.2 mg/hr q30 min to Pain Score 3/10
or GOAL RASS Score 0 to -1; to a maximum of 2 mg/hr
(No max when used for comfort measures)
<鎮静>
Propofol 1000mg/100ml
Start at 5 mcg/kg/min; titrate by 5 mcg/kg/min q 10 min
to GOAL RASS Score 0 to -1; to a maximum of 70 mcg/kg/min
Dexmedetomidine 200mcg/NS 50ml
Loading dose of 1 mcg/kg over 10 min
THEN Start at 0.2 mcg/kg/hr; titrate by 0.1 mcg/kg/hr q30 min to GOAL RASS Score 0 to -1; to a maximum 1.4 mcg/kg/hr as tolerated.
Midazolam 100mg/NS 80ml
Start at 1 mg/hr titrate by 1 mg/hr q5 min to GOAL RASS Score 0 to -1; to a maximum of 10 mg/hr
[Neuromuscular blocker]
Cisatracurium 200mg/NS 200ml
Loading dose 0.15 mg/kg = [ ]mg
Start at 3 mcg/kg/min; titrate by 0.5 mcg/kg/min q 20 min
to a maximum of 10 mcg/kg/min to a train of four (TOF)
of at least 1-2/4 to maintain ventilator synchrony
<Delirium>
- Quetiapine 25mg PO q8h sch
- Haloperidol lactate 2mg IV q8h sch
(HOLD if QTC greater than 25% increase from baseline QTC or absolute corrected QT of 0.48)
- Dexmedetomidine iv (the same protocol above)
(dexmedetomidine is the sedation medication of choice in hemodynamically stable patient with significant delirium)
(米国一施設基準)