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Hemodynamic Tolerance to IV Clonidine Infusion in the PICU*

Kleiber, Niina, MD, PhD1,2; van Rosmalen, Joost, PhD3; Tibboel, Dick, MD, PhD1; de Wildt, Saskia N., MD, PhD1,4

Pediatric Critical Care Medicine: August 2018 - Volume 19 - Issue 8 - p e409–e416
doi: 10.1097/PCC.0000000000001602
Online Clinical Investigations
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Objectives: Clonidine is an antihypertensive drug used for analgosedation in the PICU. Lack of reliable data on its hemodynamic tolerance limits its use. This study explores the hemodynamic tolerance of IV clonidine infusion in a broad population of children with high severity of disease.

Design: Retrospective analysis of prospectively collected data.

Setting: A tertiary and quaternary referral PICU.

Patients: Critically ill children age 0–18 years old who received an IV clonidine infusion for analgosedation of at least 1 hour.

Interventions: None.

Measurements and Main Results: The primary endpoints were the prevalences of bradycardia and hypotension. Secondary endpoints were changes in heart rate, blood pressure, Vasoactive-Inotropic Score, COMFORT Behavior score (a sedation scoring scale), and body temperature during the infusion. The association of bradycardia with other hemodynamic variables was explored, as well as potential risk factors for severe bradycardia. One-hundred eighty-six children (median age, 12.9 mo [interquartile range, 3.5–60.6 mo]) receiving a maximum median clonidine infusion of 0.7 µg/kg/hr (interquartile range, 0.3–1.5) were included. Severe bradycardia and systolic hypotension occurred in 72 patients (40.2%) and 105 patients (58%), respectively. Clonidine-associated bradycardia was hemodynamically well tolerated, as it was not related with hypotension and the need for vasoactive drugs decreased in parallel with a sedation score guided clonidine infusion rate increase. Younger age was the only identified risk factor for clonidine-associated bradycardia.

Conclusions: Although administration of clonidine is often associated with bradycardia and hypotension, these complications do not seem clinically significant in a mixed PICU population with a high degree of disease severity. Clonidine may have a vasoactive-inotropic sparing effect.

1Intensive Care and Department of Pediatric Surgery, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands.

2Department of General Pediatrics and Clinical Pharmacology Unit, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, QC, Canada.

3Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands.

4Department of Pharmacology and Toxicology, Radboud University, Nijmegen, The Netherlands.

*See also p. 792.

This work was performed at PICU, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands.

Dr. de Wildt’s institution received funding from EU FP7, ZonMW, the Netherlands, Stichting Nuts Ohra, and the Dutch Knowledge Center Pharmacotherapy for Children; she disclosed that she is the Director of Dutch Knowledge Center Pharmacotherapy for Children, responsible for Dutch Pediatric Drug Handbook; and she disclosed off-label product use of clonidine for ICU sedation in children. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: niina.kleiber@umontreal.ca

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies