This systematic review and meta-analysis investigates the efficacy and safety of clonidine as a sedative in critically ill patients requiring invasive mechanical ventilation.
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.
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).
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.
Mazzeo AJ. Sedation for the mechanically ventilated patient. Crit Care Clin. 1995;11:937. PubMed
Hansen-Flaschen J. Improving patient tolerance of mechanical ventilation. Challenges ahead. Crit Care Clin. 1994;10:659–71. PubMed
Hayden JC, Breatnach C, Doherty DR, et al. Efficacy of α2-agonists for sedation in pediatric critical care: a systematic review. Ped Crit Care Med. 2016;17(2):e66–75. CrossRef
Chen K, Lu Z, Xin YC, Cai Y, Chen Y, Pan SM. Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients. Cochrane Database Syst Rev. 2015;1:CD010269. PubMed
Evidence Prime, Inc. GRADEpro guideline development tool. McMaster University, 2015. Available from https://gradepro.org/.
Wang GJ, Belley-Coté E, Burry L, et al. Clonidine for sedation in the critically ill: a systematic review and meta-analysis (protocol). Syst Rev. 2015;4:154. CrossRef
Wolf A, McKay A, Spowart C, et al. Prospective multicentre randomised, double-blind, equivalence study comparing clonidine and midazolam as intravenous sedative agents in critically ill children: the SLEEPS (Safety profiLe, Efficacy and Equivalence in Paediatric intensive care Sedation) study. Health Technol Assess. 2014;18:1–212. CrossRefPubMedPubMedCentral
Farasatinasab M, Kouchek M, Sistanizad M, et al. A randomized placebo-controlled trial of clonidine impact on sedation of mechanically ventilated ICU patients. Iran J Pharmaceut Res. 2015;14:167–75.
Gillison M, Fairbairn J, McDonald K, Zvonar R, Cardinal P. Clonidine use in the intensive care unit of a tertiary care hospital: retrospective analysis. Can J Hosp Pharm. 2004;57:83–9.
- Clonidine for sedation in the critically ill: a systematic review and meta-analysis
Jing Gennie Wang
- BioMed Central
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