Tiered Approach to Clonidine Dosing to Prevent Dexmedetomidine Withdrawal in Children: A Prospective Pre and Post Interventional Cohort Study.

OBJECTIVE

To determine if implementation of a tiered clonidine dosing protocol reduces the incidence of withdrawal compared with the preintervention phase.

METHODS

This is a pre- and postinterventional cohort study in which preintervention data were collected for 6 months for baseline incidence of dexmedetomidine withdrawal and institutional practice of clonidine use. This was followed by implementation of an enteral clonidine dosing protocol based on the length of dexmedetomidine infusion and continued data collection for an additional 6 months. Patients were enrolled in both arms after ≥72 hours on dexmedetomidine. Withdrawal was described as tachycardia or hypertension and elevated Withdrawal Assessment Tool-1 or study questionnaire scores.

RESULTS

The preintervention phase had 49 patients included in analysis and the intervention phase had 30 patients. Incidence of withdrawal in the overall preintervention vs intervention cohorts was not significantly different, but in patients who received clonidine there was a trend towards less withdrawal in the intervention vs preintervention cohort (36% vs 52%). The hours on dexmedetomidine nor cumulative dexmedetomidine dose differed between the cohorts (161.5 vs 152.8 hours, p = 0.49; 126.34 vs 134.76 mcg/kg, p = 0.54). With implementation of the protocol, more patients were weaned off dexmedetomidine within 24 hours (67% vs 39%, p = 0.06).

CONCLUSIONS

To the authors' knowledge, this is the first prospective study assessing the use of an enteral clonidine dosing protocol to prevent dexmedetomidine withdrawal in children. With implementation of the protocol a trend towards reduction in withdrawal in the intervention cohort was documented despite faster weaning time with similar dexmedetomidine exposure.