Clonidine use during dexmedetomidine weaning: A systematic review

Table 3 Outcomes data

Outcomes data	Terry etal[24], 2015	Gagnon etal[23], 2015	Bhatt etal[22], 2020
Breakthrough withdrawal	NR	11	Taper 11 (73%); No taper 16 (59%)2
Discharged on clonidine	Out of ICU: 14 (54%); Out of hospital: 6 (23%)	5 (25%)	NR
Use of other agents
Propofol	NR	No individual data	Taper: 5 (33%); No taper: 8 (30%)
Ketamine	NR	NR	Taper: 1 (6.7%); No taper: 6 (22.2%)
Benzodiazepines	Clonidine: 2 (22%); No clonidine: 5 (29%)	No individual data	Taper: 3 (20%); No taper: 3 (11%)
Antipsychotics	Clonidine: 4 (44%); No clonidine: 3 (18%)	DEX maintenance dose	Taper: 9 (60%); No taper: 10 (37%) (P = 0.2)
Opioids	Clonidine: 7 (78%); No clonidine: 13 (76%)	No individual data	No individual data
Hemodynamic changes
Tachycardia	NR	NR	Taper: 12 (80%); No taper: 20 (74%)
Hypertension	NR	DEX maintenance dose: 0; Transition: 0; Clonidine maintenance: 0; Clonidine taper final day: 0; Post clonidine: 1 (6%)	Taper: 6 (40%); No taper: 8 (30%)
Bradycardia	NR	DEX maintenance dose: 0; Transition: 0; Clonidine maintenance: 1 (5%); Clonidine taper final day: 1 (6%); Post clonidine: 0	0
Hypotension	Clonidine: 4 (44%); No clonidine: 6 (35%)	DEX maintenance dose: 8 (40%); Transition: 7 (35%); Clonidine maintenance: 4 (20%); Clonidine taper final day: 2 (12%); Post clonidine: 2 (25%)	0
Sedation assessment score	RASS; Clonidine: 0 (-2 to 2); No clonidine: 0 (0-2)	SAS Score outside the goal of 3-4; DEX maintenance: 10 (50%); Transition: 10 (50%); Clonidine maintenance: 9 (45%); Clonidine taper final day 13 (76%); Post clonidine: 2 (25%)	NR
CAM ICU	Clonidine: 4 (44%); No clonidine: 3 (18%), P = 0.036	DEX maintenance: 10 (50%); Transition: 11 (55%); Clonidine maintenance: 9 (45%); Clonidine taper final day: 13 (76%); Post clonidine: 3 (38%)	Taper: 11 (73%); No taper: 17 (63%)
Duration of mechanical ventilation (d), median (IQR)	NR	3.5 (0, 10.5)	NR
Hospital length of stay (d), median (IQR)	8 (4, 10.5)	16.5 (10.5, 29.5)	NR
ICU length of stay (d), median (IQR)	12.5 (7, 28)	9.5 (5, 16.5)	Taper: 22.7; No taper: 17
Mortality	0	2 (10%)	NR

¹Systolic blood pressure (SPB) > 180/120 after stopping despite 6-d taper, but was also tapering off methadone and clonazepam so causality if not clear.

²Significant withdrawal as defined by paper (≥ 2 heart rate > 90, Confusion Assessment Method positive, Richmond Agitation-Sedation Scale > 1, SBP > 140, Withdrawal Assessment Tool Version 1 > 2).

DEX: Dexmedetomidine; NR: Not reported; SAS: Sedation-Agitation scale.