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Prevention of Withdrawal in Pediatric Patients Receiving Long-term Dexmedetomidine Infusions

Zachary J Berrens, Ashley L Sauro, Emma M Tillman

    The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
    |January 11, 2021
    PubMed

    Insights

    Adding clonidine during dexmedetomidine weaning did not reduce withdrawal symptoms like agitation or blood pressure changes. However, it did decrease abnormal heart rates, though clinical significance requires further study.

    Area of Science:

    • Pediatric Critical Care Medicine
    • Pharmacology
    • Clinical Therapeutics

    Background:

    • Prolonged dexmedetomidine infusions are used for sedation in pediatric intensive care units (PICUs).
    • Dexmedetomidine withdrawal can manifest as hemodynamic instability and agitation.
    • Clonidine is sometimes used as an adjunct to manage withdrawal symptoms.

    Purpose of the Study:

    • To investigate whether adding clonidine reduces the incidence of dexmedetomidine withdrawal in pediatric patients receiving prolonged infusions.
    • To assess the impact of clonidine on specific withdrawal symptoms, including blood pressure changes, heart rate abnormalities, and agitation.

    Main Methods:

    • Retrospective observational cohort study in a single-center pediatric intensive care unit.
    • Included children aged 1 month to 18 years receiving dexmedetomidine infusions for ≥5 days.
    • Compared outcomes between patients who received clonidine and those who did not.

    Main Results:

    • No significant difference in blood pressure changes or documented agitation between groups.
    • Patients not receiving clonidine had a higher, though not statistically significant, number of abnormal heart rate readings post-discontinuation.
    • Clonidine addition did not impact the duration of dexmedetomidine weaning or PICU length of stay.

    Conclusions:

    • Clonidine addition during long-term dexmedetomidine weaning did not lower blood pressure or agitation.
    • A decreased percentage of heart rates above the age-appropriate range was observed with clonidine, but clinical significance is uncertain.
    • Clonidine did not reduce time to dexmedetomidine weaning or shorten PICU length of stay, warranting further investigation.
    Abstract

    Keywords:
    adrenergic alpha-2 receptor agonistschildclonidinecritical caredexmedetomidinewithdrawal

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