Clonidine for Sedation in Critically Ill Adults: A Retrospective Chart Review
CCCF ePoster library. Purivatra E. Oct 3, 2017; 198220; 69
Ms. Elsa Purivatra
Ms. Elsa Purivatra
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Clonidine for Sedation in Critically Ill Adults: A Retrospective Chart Review

Purivatra, Elsa1,2; Guenette, Melanie1; Coleman, Brenda3; Burry, Lisa1,2

1 Department of Pharmacy, Mount Sinai Hospital, Toronto, Canada 2 Leslie Dan Faculty of Pharmacy, University of Toronto, Canada 3 Department of Medicine, Infectious Diseases, Mount Sinai Hospital, Toronto, Canada

Introduction The alpha2 agonist clonidine may be used as an adjunct for ICU sedation and analgesia to decrease traditional sedative and opioid requirements. However, clonidine can cause hypotension and bradycardia.

Objectives 1) To describe clonidine dosing regimens used for sedation in a mixed medical surgical ICU, as well as associated adverse events (i.e., hypotension, bradycardia, rebound withdrawal), and 2) to determine if clonidine has sparing effects on traditional drugs used for pain, sedation and agitation.

Methods We conducted a retrospective chart review of all critically ill adult patients that received at least one dose of clonidine for sedation between 2011-2016. We categorized patients as low dose (LD ≤ 0.4 mg/day) or high dose (HD > 0.4 mg/day) based on the maximum total daily clonidine dose for the analysis.

Results Of the 166 patients that met inclusion criteria, 78 (47%) received HD. The median duration of clonidine was 5 days (2, 8); therapy was discontinued without weaning for 115 (69%) patients. Hypotension was the most prevalent adverse effect amongst all patients (19.6 % with SBP < 90 mmHg and 44.6% with MAP < 65 within the first 72 hours). However, there were no significant differences between dose groups in observed rates of hypotension. Incidence of withdrawal symptoms were higher for LD compared to the HD within 25-48 hours post-clonidine discontinuation, (28% vs. 13% for rebound hypertension, p = 0.017 and 49% vs. 31% for rebound tachycardia, p = 0.022). There was a greater reduction in mean daily opioid dose for HD versus LD (mean -218.8 mcg vs. -42.5 mcg of fentanyl equivalents, p = 0.049). The decrease in sedative and non-sedative usage post-clonidine initiation was not significant. Antipsychotic dose increased for HD compared to LD (5.7 mg olanzapine equivalents vs 0 mg, p = 0.04). 

Conclusions We found clonidine daily doses were titrated beyond 0.4 mg/day in nearly half of patients; therapy was abruptly stopped for two-thirds of patients. Incorporating a tapered approach may minimize withdrawal symptoms post-clonidine cessation. Hypotension was the most prevalent adverse event but no difference based on daily dose. Titrated clonidine decreased patients’ opioid but not sedative requirements. 

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