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Continuous clonidine infusion: an alternative for children on mechanical ventilation
Cinara Carneiro Neves1, Verônica Indicatti Fiamenghi1, Patricia Scolari Fontela2
1Hospital de Clínicas de Porto Alegre, Pediatric Intensive Care Unit - Porto Alegre (RS), Brazil.
Insights
Clonidine is a well-tolerated sedative for pediatric patients on mechanical ventilation. This study found no significant hemodynamic changes or adverse effects associated with its use in this population.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Anesthesiology
Background:
- Mechanical ventilation in pediatric intensive care units (PICUs) often requires sedation.
- Clonidine, an alpha-2 adrenergic agonist, is increasingly used for sedation in critically ill children.
- Understanding clonidine's dosing and hemodynamic effects is crucial for safe and effective use.
Purpose of the Study:
- To assess clonidine infusion rates during different phases of mechanical ventilation (initial, maintenance, pre-extubation).
- To evaluate the cumulative dose of other sedatives used concurrently.
- To determine the hemodynamic response to continuous clonidine infusions in pediatric patients.
Main Methods:
- Retrospective cohort study design.
- Inclusion of pediatric patients (up to 2 years) requiring mechanical ventilation and continuous clonidine infusion.
- Analysis of clonidine doses, vasoactive-inotropic scores, heart rate, and blood pressure.
Main Results:
- Median clonidine infusion rates were 0.53 μg/kg/h (first 6h), 0.85 μg/kg/h (maintenance), and 0.63 μg/kg/h (pre-extubation).
- No significant differences in doses were observed based on the indication for mechanical ventilation.
- Clonidine infusion was not associated with significant hemodynamic changes or altered responses when used with adjuvants.
Conclusions:
- Clonidine is a well-tolerated sedation option for pediatric patients undergoing mechanical ventilation.
- Continuous clonidine infusion does not appear to significantly influence hemodynamic variables in this population.
- Further research may explore optimal dosing strategies for specific pediatric critical care scenarios.
Objective:
This study aimed to assess the clonidine infusion rate in the first 6 h, as maintenance dose (first 24 h), and in the pre-extubation period (last 24 h), as well as the cumulative dose of other sedatives and the hemodynamic response.
Methods:
This is a retrospective cohort study.
Results:
Children up to the age of 2 years who were admitted to the pediatric intensive care unit of a tertiary referral hospital in the south region of Brazil, between January 2017 and December 2018, were submitted to mechanical ventilation, and received continuous clonidine infusions were included in the study. The initial, maintenance, and pre-extubation doses of clonidine; the vasoactive-inotropic score; heart rate; and systolic and diastolic blood pressure of the study participants were assessed. A total of 66 patients with a median age of 4 months who were receiving clonidine infusions were included. The main indications for mechanical ventilation were acute viral bronchiolitis (56%) and pneumonia associated with acute respiratory distress syndrome (15%). The median of clonidine infusion in the first 6 h (66 patients) was 0.53 μg/kg/h (IQR 0.49-0.88), followed by 0.85 μg/kg/h (IQR 0.53-1.03) during maintenance (57 patients) and 0.63 μg/kg/h (IQR 0.54-1.01) during extubation period (42 patients) (p=0.03). No differences were observed in the doses regarding the indication for mechanical ventilation. Clonidine infusion was not associated with hemodynamic changes and showed no differences when associated with adjuvants.
Conclusion:
Clonidine demonstrated to be a well-tolerated sedation option in pediatric patients submitted to mechanical ventilation, without relevant influence in hemodynamic variables.
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