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Evaluation of an Enteral Clonidine Taper following Prolonged Dexmedetomidine Exposure in Critically Ill Children

Mara F Crabtree1, Cheryl L Sargel1, Colleen P Cloyd1

  • 1Department of Pharmacy, Nationwide Children's Hospital, Columbus, Ohio, United States.

Journal of Pediatric Intensive Care
|November 17, 2022
PubMed

Insights

Enteral clonidine effectively prevents and manages dexmedetomidine withdrawal symptoms in critically ill children. This transition strategy showed a low rate of taper modification, indicating its efficacy in pediatric intensive care settings.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Sedation Management

Background:

  • Dexmedetomidine is commonly used for sedation in critically ill children.
  • Withdrawal symptoms can occur after discontinuing continuous dexmedetomidine infusions.
  • Alternative strategies for managing dexmedetomidine withdrawal are needed.

Purpose of the Study:

  • To evaluate the effectiveness of enteral clonidine as a transition strategy.
  • To assess the prevention and management of dexmedetomidine withdrawal symptoms.
  • To identify risk factors for withdrawal in pediatric patients.

Main Methods:

  • Retrospective, single-center study of pediatric intensive care unit patients.
  • Inclusion criteria: ≤ 18 years, ≥ 24 hours of dexmedetomidine infusion, enteral clonidine initiated within 72 hours of discontinuation.
  • Assessment of withdrawal symptoms including hypertension, tachycardia, and agitation.

Main Results:

  • 105 patients received enteral clonidine; only 12.4% required taper modification for withdrawal.
  • Higher cumulative dexmedetomidine dose and duration were associated with increased need for taper modification.
  • Enteral clonidine was effective in preventing or managing withdrawal symptoms in most patients.

Conclusions:

  • Enteral clonidine is an effective strategy for preventing and managing dexmedetomidine withdrawal in critically ill children.
  • Identifying high-risk patients based on dexmedetomidine exposure may optimize intervention.
  • This transition approach can reduce the incidence and severity of withdrawal symptoms.

Keywords:
clonidinedexmedetomidinepediatric intensive care unittaperwithdrawal

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