Terry Kimberly, Blum Rachel, Szumita Paul
Department of Pharmacy, University of Utah Hospital, Salt Lake City, UT, USA.
Department of Pharmacy, South Shore Hospital, South Weymouth, MA, USA.
SAGE Open Med. 2015 Dec 15;3:2050312115621767. doi: 10.1177/2050312115621767. eCollection 2015.
Limited literature exists examining the use of enteral clonidine to transition patients from dexmedetomidine for management of agitation. The aim of this study was to evaluate dexmedetomidine discontinuation within 8 h of enteral clonidine administration in addition to the rates of dexmedetomidine re-initiation in patients who failed clonidine transition.
A single-center, retrospective analysis evaluated critically ill adult patients from 1 February 2013 to 28 February 2014, who used dexmedetomidine and clonidine for sedation management. Patients were excluded if they received enteral clonidine for reasons other than sedation management. Secondary aims of the study observed time to dexmedetomidine discontinuation, agitation (Richmond Agitation Sedation Scale) and delirium ratings (Confusion Assessment Method for the intensive care unit), clonidine dose, and enteral clonidine discontinuation.
In all, 26 patients were evaluated. Demographics included a mean age of 54.4 (±16.7) years, Acute Physiology and Chronic Health Evaluation II score of 18 (interquartile range = 14-22), and 80.7% of admissions to the cardiac surgery intensive care unit. Dexmedetomidine discontinuation occurred in 17 (65.4%) patients within 8 h of receiving clonidine. The total median clonidine exposure per intensive care unit day was 0.35 mg/ICU day (interquartile range = 0.2-0.5) in patients who discontinued dexmedetomidine within 8 h and 0.5 mg/ICU day (interquartile range = 0.4-1.0) (p = 0.036) in patients who did not. We observed similar Richmond Agitation Sedation Scale and Confusion Assessment Method for the intensive care unit scores and rates of hypotension. Unintentional use of clonidine beyond ICU and hospital stay was observed in 54% and 23% of patients, respectively.
Enteral clonidine may be an effective and safe alternative to transition patients off of dexmedetomidine for ongoing sedation management. Clinicians should critically evaluate the need for clonidine at ICU and hospital discharge. More studies comparing the use of clonidine to transition from dexmedetomidine infusions are needed.
关于使用肠内可乐定使患者从右美托咪定转换以管理躁动的文献有限。本研究的目的是评估在给予肠内可乐定后8小时内停用右美托咪定的情况，以及可乐定转换失败患者重新开始使用右美托咪定的比例。
一项单中心回顾性分析评估了2013年2月1日至2014年2月28日使用右美托咪定和可乐定进行镇静管理的成年重症患者。如果患者因非镇静管理原因接受肠内可乐定，则将其排除。该研究的次要目的包括观察停用右美托咪定的时间、躁动（里士满躁动镇静量表）和谵妄评分（重症监护病房意识模糊评估方法）、可乐定剂量以及停用肠内可乐定的情况。
总共评估了26例患者。人口统计学特征包括平均年龄54.4（±16.7）岁，急性生理与慢性健康状况评分II为18（四分位间距=14 - 22），80.7%的患者入住心脏外科重症监护病房。17例（65.4%）患者在接受可乐定后8小时内停用了右美托咪定。在8小时内停用右美托咪定的患者中，每个重症监护病房日可乐定的总中位暴露量为0.35mg/ICU日（四分位间距=0.2 - 0.5），未在8小时内停用右美托咪定的患者中为0.5mg/ICU日（四分位间距=0.4 - 1.0）（p = 0.036）。我们观察到里士满躁动镇静量表和重症监护病房意识模糊评估方法的评分以及低血压发生率相似。分别有54%和23%的患者在重症监护病房和住院期间意外使用了可乐定。
肠内可乐定可能是使患者从右美托咪定转换以进行持续镇静管理的一种有效且安全的替代方法。临床医生应在重症监护病房和出院时严格评估使用可乐定的必要性。需要更多比较使用可乐定从右美托咪定输注转换的研究。
