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Published on: January 17, 2011
Use of oral clonidine for sedation in ventilated paediatric intensive care patients
Sara Arenas-López1, Shelley Riphagen, Shane M Tibby
1Department of Pharmacy, Guy's Hospital, London, UK.
Insights
Oral clonidine effectively sedated mechanically ventilated children with respiratory failure, reducing the need for morphine and lorazepam. This study found no significant adverse effects, suggesting clonidine
Area of Science:
- Pediatric Intensive Care
- Pharmacology
- Respiratory Medicine
Background:
- Mechanically ventilated children with respiratory failure require effective sedation.
- Current sedation regimens may involve opioids and benzodiazepines, with potential side effects.
- Oral clonidine offers a potential alternative or adjunct for sedation.
Purpose of the Study:
- To evaluate oral clonidine as a sedative in mechanically ventilated children with respiratory failure.
- To determine the relationship between oral clonidine dose, plasma concentration, and sedative effect.
- To document the side-effect profile of oral clonidine in this population.
Main Methods:
- Prospective cohort study over 72 hours in a pediatric intensive care unit.
- Enrolled 24 children (median age 3 months) receiving mechanical ventilation.
- Measured plasma clonidine via gas chromatography-mass spectrometry and assessed sedation using the COMFORT score.
Main Results:
- Oral clonidine (3-5 microg/kg every 8 h) achieved adequate sedation for 82% of the study period.
- Plasma clonidine concentrations plateaued around 41 hours (mean 1.38 ng/ml).
- Reduced average hourly requirements for morphine (P=0.02) and lorazepam (P=0.003) were observed. No bradycardia, hypotension, or hyperglycemia occurred.
Conclusions:
- Oral clonidine appears safe and effective for sedating young children with respiratory failure.
- Clonidine may reduce the need for concomitant opioid and benzodiazepine use.
- Further pharmacokinetic studies are warranted to fully understand its use.
Objectives:
We aimed to document our experience with oral clonidine when used as a sedative in combination with intravenous morphine and lorazepam in a group of mechanically ventilated children with single-organ, respiratory failure. In particular, our objectives were to establish the relationship between oral dose, plasma concentration, and sedative effect, and second, to document the side-effect profile.
Design:
Prospective, cohort study over a 72-h period.
Setting:
Regional paediatric intensive care unit.
Patients And Participants:
Twenty-four children were enrolled (median age 3 months) of whom ten were excluded (six due to extubation before 72 h, three sedation failures, one protocol violation).
Measurements And Results:
Plasma clonidine was measured using gas chromatography mass spectrometry, and sedation assessed using the COMFORT score. Using a dose of 3-5 microg/kg every 8 h, plasma concentrations appeared to plateau at approximately 41 h giving a mean value of 1.38 ng/ml (95% confidence interval 1.0-1.8). Adequate sedation was achieved during 82% (837/1022 h) of the study period; however, this decreased to 70.3% when analysed on an intention-to-treat basis. There was a concomitant overall decrease in the average hourly requirements for both morphine ( P = 0.02) and lorazepam ( P = 0.003). There were no documented episodes of bradycardia, hypotension or hyperglycaemia.
Conclusions:
Oral clonidine may be a safe and effective sedative in combination with morphine and lorazepam for young children with single-organ, respiratory failure. This agent may also exhibit opioid and benzodiazepine sparing effects in this patient group. A full pharmacokinetic study is warranted.
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