Copyright
©The Author(s) 2023.
World J Crit Care Med. Jan 9, 2023; 12(1): 18-28
Published online Jan 9, 2023. doi: 10.5492/wjccm.v12.i1.18
Published online Jan 9, 2023. doi: 10.5492/wjccm.v12.i1.18
Ref. | Type of study | Study dates | Total patients studied | ICU | Admitting diagnosis | Mechanical ventilation | Age (yr) | Sex | Weight (kg) | BMI (kg/m2) | APACHE score |
Terry et al[24], 2015 | Single-center, retrospective, observational study | February 1, 2013-February 28, 2014 | 26 | Cardiac surgery 21 (80.7%), thoracic 3 (11.5%), neurology 1 (3.8%), surgical 1 (3.8%) | Respiratory 4 (15.4%), cardiac 20 (76.9%), trauma 1 (3.8%), substance abuse 1 (3.8%) | 4 (14.8%) | 54.4 ± 16.91 | Male: 17 (63%), female: 9 (37%) | NR | 32 ± 3.11 | 18 (14-22)2 |
Gagnon et al[23], 2015 | Single-center prospective observational pilot study | January, 2014-March, 2014 | 20 | Mixed medical, surgical, neuro ICU | Respiratory 12 (60%), neurologic 1 (5%), trauma 2 (10%), substance abuse 2 (10%), other 3 (15%) | 13 (65%) | 62 (54-73)2 | Male: 13 (65%), female: 7 (35%) | NR | 29.9 (26.5-33.1)2 | 62 (54-80)2 |
Bhatt et al[22], 2020 | Single-center, prospective, double cohort observational study | November, 2017-December, 2018 | 42 | Medical-surgical 10 (67%) vs 13 (48%), cardiothoracic 3 (20%) vs 8 (30%), neurosurgical 2 (13%) vs 6 (22%) | Respiratory 16 (38.1%), cardiac 12 (28.6%), gastroenterological 5 (11.9%), neurologic 2 (4.8%), trauma 1 (2.4%), sepsis/shock 6 (14.3%) | NR | Clonidine taper: 58 (43-662 vs no taper: 54 (45-66)2 | Male: 27 (64%), female: 15 (36%) | Clonidine taper: 86.9 (67.3-94.1)2 vs no taper 91.6 (78.9-101.1)2 (P = 0.19) | NR | NR |
Ref. | Formal protocol | Dexmedetomidine indication | Threshold for clonidine use | Initial clonidine dose | Dexmedetomidine wean | Clonidine taper |
Terry et al[24], 2015 | No | Primarily for sedation after cardiac surgery | No standard | No standard. 0.1 mg three times daily commonly used | No standard | No standard |
Gagnon et al[23], 2015 | Yes | Agitation: 12 (60%); Alcohol withdrawal: 3 (15%); Delirium: 2 (10%); Intolerance to other sedatives: 3 (15%) | Hemodynamically stable patients; Favorable response to DEX for 12-24 h | 0.2-0.5 mg every 6 h; Start at 0.2 mg with DEX doses of < 0.7 µg/kg/h, weight < 100 kg or age > 65 yr; Start with 0.5 mg every 6 h for all other patients | Decrease DEX dose by 25% of baseline within 6 h of clonidine administration (as long as no rescue meds were needed for agitation) | Extend the dosing interval to every 8, 12 and 24 h every 1-2 d as tolerated until discontinuation |
Bhatt et al[22], 2020 | Yes | No clear selection criteria; patients with substance withdrawal were excluded | Variable; Clonidine taper and DEX wean started together | 0.3 or 0.2 mg every 6 h; Start at 0.2 mg with DEX < 0.7 µg/kg/h, weight < 100 kg, age > 65 yr old; Start with 0.3 mg every 6 h for all other patients | Decrease DEX dose by 25% of baseline from 0 h to 6 h, and continue dose reduction by 25% every 6 h while on clonidine | Extend the dosing interval to every 8, 12 and 24 h every 1-2 d as tolerated until discontinuation |
Outcomes data | Terry etal[24], 2015 | Gagnon etal[23], 2015 | Bhatt etal[22], 2020 |
Breakthrough withdrawal | NR | 11 | Taper 11 (73%); No taper 16 (59%)2 |
Discharged on clonidine | Out of ICU: 14 (54%); Out of hospital: 6 (23%) | 5 (25%) | NR |
Use of other agents | |||
Propofol | NR | No individual data | Taper: 5 (33%); No taper: 8 (30%) |
Ketamine | NR | NR | Taper: 1 (6.7%); No taper: 6 (22.2%) |
Benzodiazepines | Clonidine: 2 (22%); No clonidine: 5 (29%) | No individual data | Taper: 3 (20%); No taper: 3 (11%) |
Antipsychotics | Clonidine: 4 (44%); No clonidine: 3 (18%) | DEX maintenance dose | Taper: 9 (60%); No taper: 10 (37%) (P = 0.2) |
Opioids | Clonidine: 7 (78%); No clonidine: 13 (76%) | No individual data | No individual data |
Hemodynamic changes | |||
Tachycardia | NR | NR | Taper: 12 (80%); No taper: 20 (74%) |
Hypertension | NR | DEX maintenance dose: 0; Transition: 0; Clonidine maintenance: 0; Clonidine taper final day: 0; Post clonidine: 1 (6%) | Taper: 6 (40%); No taper: 8 (30%) |
Bradycardia | NR | DEX maintenance dose: 0; Transition: 0; Clonidine maintenance: 1 (5%); Clonidine taper final day: 1 (6%); Post clonidine: 0 | 0 |
Hypotension | Clonidine: 4 (44%); No clonidine: 6 (35%) | DEX maintenance dose: 8 (40%); Transition: 7 (35%); Clonidine maintenance: 4 (20%); Clonidine taper final day: 2 (12%); Post clonidine: 2 (25%) | 0 |
Sedation assessment score | RASS; Clonidine: 0 (-2 to 2); No clonidine: 0 (0-2) | SAS Score outside the goal of 3-4; DEX maintenance: 10 (50%); Transition: 10 (50%); Clonidine maintenance: 9 (45%); Clonidine taper final day 13 (76%); Post clonidine: 2 (25%) | NR |
CAM ICU | Clonidine: 4 (44%); No clonidine: 3 (18%), P = 0.036 | DEX maintenance: 10 (50%); Transition: 11 (55%); Clonidine maintenance: 9 (45%); Clonidine taper final day: 13 (76%); Post clonidine: 3 (38%) | Taper: 11 (73%); No taper: 17 (63%) |
Duration of mechanical ventilation (d), median (IQR) | NR | 3.5 (0, 10.5) | NR |
Hospital length of stay (d), median (IQR) | 8 (4, 10.5) | 16.5 (10.5, 29.5) | NR |
ICU length of stay (d), median (IQR) | 12.5 (7, 28) | 9.5 (5, 16.5) | Taper: 22.7; No taper: 17 |
Mortality | 0 | 2 (10%) | NR |
- Citation: Rajendraprasad S, Wheeler M, Wieruszewski E, Gottwald J, Wallace LA, Gerberi D, Wieruszewski PM, Smischney NJ. Clonidine use during dexmedetomidine weaning: A systematic review. World J Crit Care Med 2023; 12(1): 18-28
- URL: https://www.wjgnet.com/2220-3141/full/v12/i1/18.htm
- DOI: https://dx.doi.org/10.5492/wjccm.v12.i1.18