Rajendraprasad S, Wheeler M, Wieruszewski E, Gottwald J, Wallace LA, Gerberi D, Wieruszewski PM, Smischney NJ. Clonidine use during dexmedetomidine weaning: A systematic review. World J Crit Care Med 2023; 12(1): 18-28 [PMID: 36683967 DOI: 10.5492/wjccm.v12.i1.18]
Corresponding Author of This Article
Nathan J Smischney, MD, MS, Associate Professor, Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. smischney.nathan@mayo.edu
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Jan 9, 2023; 12(1): 18-28 Published online Jan 9, 2023. doi: 10.5492/wjccm.v12.i1.18
Clonidine use during dexmedetomidine weaning: A systematic review
Sanu Rajendraprasad, Molly Wheeler, Erin Wieruszewski, Joseph Gottwald, Lindsey A. Wallace, Danielle Gerberi, Patrick M Wieruszewski, Nathan J Smischney
Sanu Rajendraprasad, Department of Pulmonary & Critical Care, Mayo Clinic, Rochester, MN 55905, United States
Molly Wheeler, Erin Wieruszewski, Patrick M Wieruszewski, Department of Pharmacy, Mayo Clinic, Rochester, MN 55905, United States
Joseph Gottwald, Nathan J Smischney, Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, United States
Lindsey A. Wallace, Critical Care Medicine Independent Multidisciplinary Program, Mayo Clinic, Rochester, MN 55905, United States
Danielle Gerberi, Mayo Medical Libraries, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Rajendraprasad S, Wieruszewski P, and Smischney N designed the research; Rajendraprasad S, Wheeler M, and Wieruszewski E performed the research; Gottwald J and Wallace L analyzed the data; Rajendraprasad S, Wheeler M, Gottwald J, Wallace L, Wieruszewski P, and Smischney N drafted the paper; All authors reviewed and edited the manuscript and approved the final version.
Conflict-of-interest statement: All authors declare no conflicts of interest.
PRISMA 2009 Checklist statement: The study followed the PRISMA guidelines. The protocol was a priori registered in the PROSPERO database (No. CRD42022330666).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nathan J Smischney, MD, MS, Associate Professor, Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. smischney.nathan@mayo.edu
Received: September 13, 2022 Peer-review started: September 13, 2022 First decision: October 21, 2022 Revised: November 15, 2022 Accepted: November 30, 2022 Article in press: November 30, 2022 Published online: January 9, 2023 Processing time: 111 Days and 10.5 Hours
ARTICLE HIGHLIGHTS
Research background
Clonidine, an enterally available alpha-2A adrenergic agonist, may be a suitable agent to taper off parenteral dexmedetomidine (centrally acting alpha-2A adrenergic agonist) and reduce withdrawal syndromes. This could lead to reduced intensive care unit (ICU) length of stay (LOS), among other outcomes. However, limited data exist on this topic.
Research motivation
To determine if oral clonidine is useful to wean off parenteral dexmedetomine and reduce ICU LOS.
Research objectives
To systematically review the practice, dosing schema, and outcomes of enteral clonidine use during dexmedetomidine weaning in critically ill adults.
Research methods
This was a systematic review of randomized controlled trials, prospective and retrospective cohorts, on the use of enteral clonidine during dexmedetomidine weaning in critically ill adults (≥ 18 years). The primary outcomes of interest were dosing and titration schema of enteral clonidine and dexmedetomidine and risk factors for dexmedetomidine withdrawal.
Research results
Three observational studies were included (two prospective and one retrospective). Weaning time ranged from 13 to 167 h on average. The adverse events associated with enteral clonidine use were higher than patients on dexmedetomidine taper alone with increased agitation. The re-initiation of dexmedetomidine was not documented in any study. Only 17 (37%) patients were mechanically ventilated with median duration of 3.5 d for 13 patients in one of the 2 studies. ICU lengths of stay were similar.
Research conclusions
Enteral clonidine is a strategy to wean critically ill patients from parenteral dexmedetomidine. However, there is an association of increased withdrawal symptoms and agitation with the use of a clonidine taper.
Research perspectives
It is unclear if oral clonidine is useful in weaning from dexmedetomidine. More data are needed in terms of both dosing schedule and outcomes.
