Clonidine for Dexmedetomidine Withdrawal in Pediatric Patients: A Single Center's Experience

Beitz, Erin R.; Seabury, Robert W.; Miller, Christopher D.; Darko, William; Probst, Luke A.; Steidl, Kelly E.

doi:10.5863/1551-6776-24.6.542

Cited by 3 publications

(4 citation statements)

References 4 publications

(8 reference statements)

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“…There were no prospective studies of weaning from dexmedetomidine. We identified three retrospective studies of withdrawal symptoms (7,11,12) and the use of clonidine (16)(17)(18). One study identified the dose above which withdrawal occurs in critically ill children weaning from dexmedetomidine (7).…”

Section: Resultsmentioning

confidence: 99%

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Weaning Dexmedetomidine in Non-ICU Areas: An Implementation Effort

Solodiuk

Sweet

Greco

et al. 2022

Pediatric Critical Care Medicine

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To develop and implement clinical practice guidelines for safely weaning dexmedetomidine infusions in non-ICU areas.DESIGN: Development, implementation, and analysis of effectiveness of clinical practice guidelines. SETTING:Quaternary care academic free-standing pediatric hospital. PATIENTS:Children, otherwise medically ready for transfer to non-ICU areas, who were undergoing a planned wean of a dexmedetomidine infusion. INTERVENTIONS:Subject matter experts developed evidence-based guidelines for weaning dexmedetomidine in patients whose critical phase of illness had resolved. MEASUREMENTS AND MAIN RESULTS:Searches identified no prospective studies of dexmedetomidine weaning. We identified two retrospective reviews of withdrawal symptoms and one on the use of clonidine. There were case studies on withdrawal symptoms. Guidelines were piloted on a cohort of 24 patients while in the ICU. The guidelines were then implemented in non-ICU areas for patients undergoing dexmedetomidine weaning after ICU transfer. Over a 2-year period (October 1, 2018, to September 30, 2020), 63 patients (1 mo to 18 yr old) successfully weaned dexmedetomidine in non-ICU areas. The median time to discontinuation of dexmedetomidine after transfer to non-ICU areas was 5.8 days (interquartile range, 4.75-15 d). Fifty-eight percent (n = 41) of all patients were considered high risk for dexmedetomidine withdrawal based on the dose, duration of exposure, and the risk of experiencing physiologic detriment with more than mild withdrawal. Twenty-nine patients (46%) exhibited no signs or symptoms of withdrawal while weaning per guidelines. For those with signs and symptoms of withdrawal, the most common were tachycardia (n = 26, 40%), agitation (n = 9, 14%), and hypertension (n = 9, 11%). CONCLUSIONS:Weaning dexmedetomidine in non-ICU areas is feasible and can be accomplished safely even among pediatric patients at high risk for withdrawal using standardized weaning guidelines. At our institution, implementation was associated with reduced ICU length of stay for patients recovering from critical illness.

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Section: Resultsmentioning

confidence: 99%

“…In animal models, an eight-fold higher affinity of dexmedetomidine to clonidine for alpha 2 receptors was reported (17). However, the direct conversions between the two agents and translation to clinical practice still remain unknown (18, 19).…”

Section: Discussionmentioning

confidence: 99%

Weaning Dexmedetomidine in Non-ICU Areas: An Implementation Effort

Solodiuk

Sweet

Greco

et al. 2022

Pediatric Critical Care Medicine

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“…Additionally, there is significant variation in current conversion practices with clonidine dosing ranging from 1.4 to 18 µg/kg/day, divided at differing frequencies. 11,13,[16][17][18] This study aims to describe the use of an enteral clonidine transition for the prevention and management of dexmedetomidine withdrawal in critically ill children not exposed to other continuous infusion sedative agents. Secondary outcomes seek to describe the characteristics of dexmedetomidine exposure associated with a need for a clonidine taper modification and to describe the prevalence of dexmedetomidine withdrawal symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, there is significant variation in current conversion practices with clonidine dosing ranging from 1.4 to 18 µg/kg/day, divided at differing frequencies. 11 13 16 17 18…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an Enteral Clonidine Taper following Prolonged Dexmedetomidine Exposure in Critically Ill Children

Crabtree

Sargel

Cloyd

et al. 2021

J Pediatr Intensive Care

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The aim of the current study is to evaluate the use of an enteral clonidine transition for the prevention or management of dexmedetomidine withdrawal symptoms in critically ill children not exposed to other continuous infusion sedative agents. A retrospective, single-center study was conducted in patients ≤ 18 years of age admitted to the pediatric intensive care unit who received a continuous infusion of dexmedetomidine for ≥ 24 hours and who were prescribed enteral clonidine within 72 hours of dexmedetomidine discontinuation. Predefined withdrawal terminology was established to assess for hypertension, tachycardia, agitation, tremors, and decreased sleep. A total of 105 patients were included and received enteral clonidine for prevention or management of dexmedetomidine withdrawal symptoms, with 13 patients (12.4%) requiring a taper modification to manage withdrawal symptoms. The median duration of dexmedetomidine infusion was 120.5 hours (95.5, 143.5) and median peak infusion rate was 1 µg/kg/h (1, 1.2). A higher cumulative dexmedetomidine dose of 119.2 µg/kg (96.6, 154.9) and duration of 142.9 hours (122.6, 158.3) were noted in patients who required a taper modification. Risk factors for dexmedetomidine withdrawal such as dexmedetomidine duration and cumulative dose may help predict patients at the highest risk of withdrawal that would benefit from an enteral clonidine taper to prevent dexmedetomidine withdrawal symptoms. An enteral clonidine taper can be effective in the prevention and management of dexmedetomidine withdrawal symptoms.

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Clonidine for Dexmedetomidine Withdrawal in Pediatric Patients: A Single Center's Experience

Cited by 3 publications

References 4 publications

Weaning Dexmedetomidine in Non-ICU Areas: An Implementation Effort

Weaning Dexmedetomidine in Non-ICU Areas: An Implementation Effort

Evaluation of an Enteral Clonidine Taper following Prolonged Dexmedetomidine Exposure in Critically Ill Children

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