Systematic Reviews
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
Table 1 Trial characteristics
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], 2015Single-center, retrospective, observational studyFebruary 1, 2013-February 28, 201426Cardiac 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 ± 16.91Male: 17 (63%), female: 9 (37%)NR32 ± 3.1118 (14-22)2
Gagnon et al[23], 2015Single-center prospective observational pilot studyJanuary, 2014-March, 201420Mixed medical, surgical, neuro ICURespiratory 12 (60%), neurologic 1 (5%), trauma 2 (10%), substance abuse 2 (10%), other 3 (15%)13 (65%)62 (54-73)2Male: 13 (65%), female: 7 (35%)NR29.9 (26.5-33.1)262 (54-80)2
Bhatt et al[22], 2020Single-center, prospective, double cohort observational studyNovember, 2017-December, 201842Medical-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%)NRClonidine taper: 58 (43-662 vs no taper: 54 (45-66)2 (P = 0.93)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)NRNR
Table 2 Dosing schemes reported in study methods
Ref.
Formal protocol
Dexmedetomidine indication
Threshold for clonidine use
Initial clonidine dose
Dexmedetomidine wean
Clonidine taper
Terry et al[24], 2015NoPrimarily for sedation after cardiac surgeryNo standardNo standard. 0.1 mg three times daily commonly usedNo standardNo standard
Gagnon et al[23], 2015YesAgitation: 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 h0.2-0.5 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 patientsDecrease 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], 2020YesNo clear selection criteria; patients with substance withdrawal were excludedVariable; Clonidine taper and DEX wean started together0.3 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 patientsDecrease DEX dose by 25% of baseline from 0 h to 6 h, and continue dose reduction by 25% every 6 h while on clonidineExtend the dosing interval to every 8, 12 and 24 h every 1-2 d as tolerated until discontinuation
Table 3 Outcomes data
Outcomes data
Terry etal[24], 2015
Gagnon etal[23], 2015
Bhatt etal[22], 2020
Breakthrough withdrawalNR11Taper 11 (73%); No taper 16 (59%)2
Discharged on clonidineOut of ICU: 14 (54%); Out of hospital: 6 (23%)5 (25%)NR
Use of other agents
PropofolNRNo individual dataTaper: 5 (33%); No taper: 8 (30%)
KetamineNRNRTaper: 1 (6.7%); No taper: 6 (22.2%)
BenzodiazepinesClonidine: 2 (22%); No clonidine: 5 (29%)No individual dataTaper: 3 (20%); No taper: 3 (11%)
AntipsychoticsClonidine: 4 (44%); No clonidine: 3 (18%)DEX maintenance doseTaper: 9 (60%); No taper: 10 (37%) (P = 0.2)
OpioidsClonidine: 7 (78%); No clonidine: 13 (76%)No individual dataNo individual data
Hemodynamic changes
Tachycardia NRNRTaper: 12 (80%); No taper: 20 (74%)
HypertensionNRDEX maintenance dose: 0; Transition: 0; Clonidine maintenance: 0; Clonidine taper final day: 0; Post clonidine: 1 (6%)Taper: 6 (40%); No taper: 8 (30%)
BradycardiaNRDEX maintenance dose: 0; Transition: 0; Clonidine maintenance: 1 (5%); Clonidine taper final day: 1 (6%); Post clonidine: 00
HypotensionClonidine: 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 scoreRASS; 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 ICUClonidine: 4 (44%); No clonidine: 3 (18%), P = 0.036DEX 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)NR3.5 (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
Mortality02 (10%)NR