Hemodynamic Tolerance to IV Clonidine Infusion in the PICU
Niina Kleiber1,2, Joost van Rosmalen3, Dick Tibboel1
1Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Summary
Intravenous clonidine infusion for pediatric analgosedation in critically ill children is generally well-tolerated. While bradycardia and hypotension occurred, they were hemodynamically stable and may reduce the need for other vasoactive drugs.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Anesthesiology
Background:
- Clonidine is an antihypertensive medication used for analgosedation in pediatric intensive care units (PICUs).
- Limited data exists on the hemodynamic tolerance of intravenous clonidine in critically ill children, restricting its use.
- This study addresses the need for reliable data on clonidine's hemodynamic effects in this population.
Purpose of the Study:
- To evaluate the hemodynamic tolerance of intravenous clonidine infusion in a diverse group of critically ill children.
- To determine the incidence of bradycardia and hypotension associated with clonidine infusion.
- To explore the relationship between clonidine-induced bradycardia and other hemodynamic parameters, and identify risk factors.
Main Methods:
- Retrospective analysis of prospectively collected data from a tertiary and quaternary referral PICU.
- Inclusion criteria: critically ill children (0-18 years) receiving IV clonidine infusion for analgosedation for at least 1 hour.
- Primary endpoints: prevalence of bradycardia and hypotension. Secondary endpoints: heart rate, blood pressure, Vasoactive-Inotropic Score, COMFORT Behavior score, and body temperature changes.
Main Results:
- 186 children received clonidine infusions (median 0.7 µg/kg/hr).
- Severe bradycardia occurred in 40.2% and systolic hypotension in 58% of patients.
- Clonidine-associated bradycardia was well-tolerated, not linked to hypotension, and associated with decreased vasoactive drug needs as sedation increased. Younger age was the sole risk factor for bradycardia.
Conclusions:
- Intravenous clonidine for analgosedation in critically ill children is hemodynamically tolerated, even with high disease severity.
- Observed bradycardia and hypotension appear clinically insignificant.
- Clonidine may offer a vasoactive-inotropic sparing effect, potentially reducing the need for other medications.
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