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.
Insights
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.
Objectives:
Clonidine is an antihypertensive drug used for analgosedation in the PICU. Lack of reliable data on its hemodynamic tolerance limits its use. This study explores the hemodynamic tolerance of IV clonidine infusion in a broad population of children with high severity of disease.
Design:
Retrospective analysis of prospectively collected data.
Setting:
A tertiary and quaternary referral PICU.
Patients:
Critically ill children age 0-18 years old who received an IV clonidine infusion for analgosedation of at least 1 hour.
Interventions:
None.
Measurements And Main Results:
The primary endpoints were the prevalences of bradycardia and hypotension. Secondary endpoints were changes in heart rate, blood pressure, Vasoactive-Inotropic Score, COMFORT Behavior score (a sedation scoring scale), and body temperature during the infusion. The association of bradycardia with other hemodynamic variables was explored, as well as potential risk factors for severe bradycardia. One-hundred eighty-six children (median age, 12.9 mo [interquartile range, 3.5-60.6 mo]) receiving a maximum median clonidine infusion of 0.7 µg/kg/hr (interquartile range, 0.3-1.5) were included. Severe bradycardia and systolic hypotension occurred in 72 patients (40.2%) and 105 patients (58%), respectively. Clonidine-associated bradycardia was hemodynamically well tolerated, as it was not related with hypotension and the need for vasoactive drugs decreased in parallel with a sedation score guided clonidine infusion rate increase. Younger age was the only identified risk factor for clonidine-associated bradycardia.
Conclusions:
Although administration of clonidine is often associated with bradycardia and hypotension, these complications do not seem clinically significant in a mixed PICU population with a high degree of disease severity. Clonidine may have a vasoactive-inotropic sparing effect.
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