Published online Jan 9, 2023. doi: 10.5492/wjccm.v12.i1.18
Peer-review started: September 13, 2022
First decision: October 21, 2022
Revised: November 15, 2022
Accepted: November 30, 2022
Article in press: November 30, 2022
Published online: January 9, 2023
Processing time: 111 Days and 10.5 Hours
Clonidine, an enterally available alpha-2A adrenergic agonist, may be a suitable agent to taper off parenteral dexmedetomidine (centrally acting alpha-2A adrenergic agonist) and reduce withdrawal syndromes. This could lead to reduced intensive care unit (ICU) length of stay (LOS), among other outcomes. However, limited data exist on this topic.
To determine if oral clonidine is useful to wean off parenteral dexmedetomine and reduce ICU LOS.
To systematically review the practice, dosing schema, and outcomes of enteral clonidine use during dexmedetomidine weaning in critically ill adults.
This was a systematic review of randomized controlled trials, prospective and retrospective cohorts, on the use of enteral clonidine during dexmedetomidine weaning in critically ill adults (≥ 18 years). The primary outcomes of interest were dosing and titration schema of enteral clonidine and dexm
Three observational studies were included (two prospective and one retrospective). Weaning time ranged from 13 to 167 h on average. The adverse events associated with enteral clonidine use were higher than patients on dexmedetomidine taper alone with increased agitation. The re-initiation of dexmedetomidine was not documented in any study. Only 17 (37%) patients were mechanically ventilated with median duration of 3.5 d for 13 patients in one of the 2 studies. ICU lengths of stay were similar.
Enteral clonidine is a strategy to wean critically ill patients from parenteral dexmedetomidine. However, there is an association of increased withdrawal symptoms and agitation with the use of a clonidine taper.
It is unclear if oral clonidine is useful in weaning from dexmedetomidine. More data are needed in terms of both dosing schedule and outcomes.