Clonidine use during dexmedetomidine weaning:A systematic review  

作　　者：Sanu Rajendraprasad Molly Wheeler Erin Wieruszewski Joseph Gottwald Lindsey A.Wallace Danielle Gerberi Patrick M Wieruszewski Nathan J Smischney 

机构地区：[1]Department of Pulmonary&Critical Care,Mayo Clinic,Rochester,MN 55905,United States [2]Department of Pharmacy,Mayo Clinic,Rochester,MN 55905,United States [3]Department of Anesthesiology&Perioperative Medicine,Mayo Clinic,Rochester,MN 55905,United States [4]Critical Care Medicine Independent Multidisciplinary Program,Mayo Clinic,Rochester,MN 55905,United States [5]Mayo Medical Libraries,Mayo Clinic,Rochester,MN 55905,United States

出　　处：《World Journal of Critical Care Medicine》2023年第1期18-28,共11页世界重症医学杂志

摘　　要：BACKGROUND Dexmedetomidine is a centrally acting alpha-2A adrenergic agonist that is commonly used as a sedative and anxiolytic in the intensive care unit(ICU),with prolonged use increasing risk of withdrawal symptoms upon sudden discontinuation.As clonidine is an enterally available alpha-2A adrenergic agonist,it may be a suitable agent to taper off dexmedetomidine and reduce withdrawal syndromes.The appropriate dosing and conversion strategies for using enteral clonidine in this context are not known.The objective of this systematic review is to summarize the evidence of enteral clonidine application during dexmedetomidine weaning for prevention of withdrawal symptoms.AIM To systematically review the practice,dosing schema,and outcomes of enteral clonidine use during dexmedetomidine weaning in critically ill adults.METHODS This was a systematic review of enteral clonidine used during dexmedetomidine weaning in critically ill adults(≥18 years).Randomized controlled trials,prospective cohorts,and retrospective cohorts evaluating the use of clonidine to wean patients from dexmedetomidine in the critically ill were included.The primary outcomes of interest were dosing and titration schema of enteral clonidine and dexmedetomidine and risk factors for dexmedetomidine withdrawal.Other secondary outcomes included prevalence of adverse events associated with enteral clonidine use,re-initiation of dexmedetomidine,duration of mechanical ventilation,and ICU length of stay.RESULTS A total of 3427 studies were screened for inclusion with three meeting inclusion criteria with a total of 88 patients.All three studies were observational,two being prospective and one retrospective.In all included studies,the choice to start enteral clonidine to wean off dexmedetomidine was made at the discretion of the physician.Weaning time ranged from 13 to 167 h on average.Enteral clonidine was started in the prospective studies in a similar protocolized method,with 0.3 mg every 6 h.After starting clonidine,patients remained on dexmedetomid

关 键 词：CLONIDINE DEXMEDETOMIDINE Intensive care unit WITHDRAWAL WEANING 

分 类 号：R72[医药卫生—儿科]