Evaluation of Clonidine Utilization for Dexmedetomidine Discontinuation in the Intensive Care Unit

Abstract

Purpose

Previous studies evaluating clonidine for dexmedetomidine weaning in critically ill patients have shown efficacy but are limited to smaller samples of adult or pediatric patients. The objective of this study was to evaluate the efficacy and safety of enteral clonidine in the transition from dexmedetomidine for agitation and sedation in the intensive care unit (ICU).

Materials and Methods

This was a single-center, retrospective cohort study of adult patients admitted to an ICU at UMass Memorial Medical Center between May 1, 2022 to April 30, 2023 who received enteral clonidine for the indication of weaning dexmedetomidine. The primary outcome was discontinuation of dexmedetomidine within 24 h of starting enteral clonidine. A priori risk factors for the primary outcome included duration of dexmedetomidine prior to clonidine initiation, clonidine total daily dose, average Richmond Agitation-Sedation Scale (RASS) and Sequential Organ Failure Assessment (SOFA) scores, history of a psychiatric disorder, intubation at time of clonidine initiation, and being on additional sedation agents at the time of clonidine initiation. Safety outcomes included the incidence of bradycardia, hypotension, and withdrawal.

Results

Seventy-three patients were included. The primary outcome of dexmedetomidine discontinuation within 24 h occurred in 38 patients (52%). Multivariable logistic regression analysis of the a priori risk factors indicated that non-intubated patients at the time of clonidine initiation were significantly more likely to achieve the primary outcome (OR 4.27, 95% CI 1.04-17.62, p = 0.04). Incidence of bradycardia (5% clonidine vs 16% dexmedetomidine, p = 0.04) and withdrawal (0% vs 49%, p < 0.0001) were higher while patients were on dexmedetomidine.

Conclusions

Clonidine was efficacious in weaning dexmedetomidine within 24 h in 52% of patients; however, the ideal dose and period for initiation remains unclear. Results of this study warrant further investigation to identify optimal clonidine dosing for dexmedetomidine weaning and to characterize patient populations that would benefit most from this intervention.