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Crit Care. 2017 Feb 25;21(1):75. doi: 10.1186/s13054-017-1610-8.

Clonidine for sedation in the critically ill: a systematic review and meta-analysis.

Author information

1
Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
2
Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
3
Department of Pharmacy, Mount Sinai Hospital, Toronto, ON, Canada.
4
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
5
Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
6
Hamilton Health Sciences, Hamilton, ON, Canada.
7
St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
8
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
9
Department of Anesthesia, University of Toronto, Toronto, ON, Canada.
10
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
11
Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. bram.rochwerg@gmail.com.
12
Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada. bram.rochwerg@gmail.com.

Abstract

BACKGROUND:

This systematic review and meta-analysis investigates the efficacy and safety of clonidine as a sedative in critically ill patients requiring invasive mechanical ventilation.

METHODS:

We performed a comprehensive search of MEDLINE, EMBASE, CINAHL and the Cochrane trial registry. We identified RCTs that compared clonidine to any non-clonidine regimen in critically ill patients, excluding neonates, requiring mechanical ventilation. The GRADE method was used to assess certainty of evidence.

RESULTS:

We included eight RCTs (n = 642 patients). In seven of the trials clonidine was used for adjunctive rather than stand-alone sedation. There was no difference in the duration of mechanical ventilation (mean difference (MD) 0.05 days, 95% confidence interval (CI) = -0.65 to 0.75, I 2  = 86%, moderate certainty), ICU mortality (relative risk (RR) 0.98, 95% CI = 0.51 to 1.90, I 2  = 0%, low certainty), or ICU length of stay (MD 0.04 days, 95% CI = -0.46 to 0.53, I 2  = 16%, moderate certainty), with clonidine. There was a significant reduction in the total dose of narcotics (standard mean difference (SMD) -0.26, 95% CI = -0.50 to -0.02, I 2  = 0%, moderate certainty) with clonidine use. Clonidine was associated with increased incidence of clinically significant hypotension (RR 3.11, 95% CI = 1.64 to 5.87, I 2  = 0%, moderate certainty).

CONCLUSIONS:

Until further RCTs are performed, data remains insufficient to support the routine use of clonidine as a sedative in the mechanically ventilated population. Clonidine may act as a narcotic-sparing agent, albeit with an increased risk of clinically significant hypotension.

KEYWORDS:

Clonidine; Delirium; Mechanical ventilation; Sedation; Systematic review; Weaning

PMID:
28330506
PMCID:
PMC5363026
DOI:
10.1186/s13054-017-1610-8
[Indexed for MEDLINE]
Free PMC Article

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