Pediatric Resident Children's Hospital at Erlanger Chattanooga, Tennessee, United States
Background: Adequate sedation and analgesia are important factors in the pediatric critical care setting. Of the many agents available, dexmedetomidine, an alpha-2 adrenergic agonist, is an increasingly popular option as a preferred additive medication for sedation. It has been shown to reduce the duration of mechanical ventilation as well as ICU length of stay. There is currently limited data describing potential withdrawal effects from dexmedetomidine. Clonidine is a pharmacologically similar oral agent with a long history of use in pediatric patients. Several studies have supported a bridge to clonidine to prevent dexmedetomidine withdrawal. There are no clearly defined protocols for transitioning from intravenous dexmedetomidine to enteral clonidine.
Objective: This study aims to analyze our institution’s current dexmedetomidine/clonidine conversion practice. We will review the current and cumulative dexmedetomidine dose at time of enteral clonidine initiation and identify patients requiring clonidine dose escalation due to suspected dexmedetomidine withdrawal.
Design/Methods: Retrospective medical record review of patients admitted to the pediatric intensive care unit of a single tertiary care children’s hospital. All patients who received dexmedetomidine infusions for greater than 24 hours and initiation of enteral clonidine between January 1, 2017 and January 1, 2022 were reviewed.
Results: Forty three patients were included in the analysis. Twenty five patients required an increase in initial clonidine dose with an average cumulative dexmedetomidine dose of 422.03 mcg/kg. In this group, average initial daily clonidine doses began at 6.29 mcg/kg/day with escalation to an average of 10.93 mcg/kg/day. Duration of dexmedetomidine exposure in the escalation group averaged 19.4 days. For the 18 patients that did not require an increase in clonidine dose, the average cumulative dexmedetomidine dose was 202.15 mcg/kg with an average daily clonidine dose of 5.95 mcg/kg/day. Duration of dexmedetomidine exposure averaged 11.7 days.
Conclusion(s): Formal statistical analysis is currently pending, and will be complete prior to presentation of this study. Preliminary data suggests a correlation between higher cumulative dexmedetomidine dosage and a higher daily clonidine dosage required to mitigate potential withdrawal effects of dexmedetomidine. Findings also support the need for an institutional conversion protocol.