Bhatt Krupa, Thompson Quan Ashley, Baumgartner Laura, Jia Shawn, Croci Rhiannon, Puntillo Kathleen, Ramsay James, Bouajram Rima H
Department of Pharmacy, Scripps Memorial Hospital La Jolla, La Jolla, CA.
Department of Pharmaceutical Services, University of California, San Francisco Medical Center, San Francisco, CA.
Crit Care Explor. 2020 Nov 3;2(11):e0245. doi: 10.1097/CCE.0000000000000245. eCollection 2020 Nov.
Prolonged use of dexmedetomidine has become increasingly common due to its favorable sedative and anxiolytic properties. Hypersympathetic withdrawal symptoms have been reported with abrupt discontinuation of prolonged dexmedetomidine infusions. Clonidine has been used to transition patients off dexmedetomidine infusions for ICU sedation. The objective of this study was to compare the occurrence of dexmedetomidine withdrawal symptoms in ICU patients transitioning to a clonidine taper versus those weaned off dexmedetomidine alone after prolonged dexmedetomidine infusion.
This was a single-center, prospective, double cohort observational study conducted from November 2017 to December 2018.
Medical-surgical, cardiothoracic, and neurosurgical ICUs in a tertiary care hospital.
We included adult ICU patients being weaned off dexmedetomidine after receiving continuous infusions for at least 3 days.
Patients were either weaned off dexmedetomidine alone or with a clonidine taper at the discretion of the providers.
The primary outcome was the incidence of at least two dexmedetomidine withdrawal symptoms during a single assessment within 24 hours of dexmedetomidine discontinuation. Time on dexmedetomidine after wean initiation and difference in medication cost were also evaluated. Forty-two patients were included in this study: 15 received clonidine (Group C) and 27 weaned off dexmedetomidine alone (Group D). There was no significant difference in the incidence of two or more withdrawal symptoms between groups (73% in Group C vs 59% in Group D; = 0.51). Patients in Group C spent less time on dexmedetomidine after wean initiation compared with patients in Group D (19 vs 42 hr; = 0.02). An average cost savings of $1,553.47 per patient who received clonidine was observed. No adverse effects were noted.
Our study demonstrated that patients receiving clonidine were able to wean off dexmedetomidine more rapidly, with a considerable cost savings and no difference in dexmedetomidine withdrawal symptoms, compared with patients weaned off dexmedetomidine alone. Clonidine may be a safe, effective, and practical option to transition patients off prolonged dexmedetomidine infusions.
右美托咪定因其良好的镇静和抗焦虑特性，其长期使用已变得越来越普遍。据报道，长期输注右美托咪定后突然停药会出现交感神经过度减退症状。可乐定已被用于帮助重症监护病房（ICU）接受镇静治疗的患者从右美托咪定输注过渡停药。本研究的目的是比较在长期输注右美托咪定后，ICU患者在改用可乐定逐渐减量停药与单纯停用右美托咪定过程中，右美托咪定撤药症状的发生情况。
这是一项于2017年11月至2018年12月进行的单中心、前瞻性、双队列观察性研究。
一家三级医院的内科、外科、心胸外科和神经外科重症监护病房。
我们纳入了在接受持续输注至少3天后正在停用右美托咪定的成年ICU患者。
由医护人员自行决定，患者要么单纯停用右美托咪定，要么在停用右美托咪定的同时逐渐减少可乐定用量。
主要结局是在停用右美托咪定后24小时内的单次评估中出现至少两种右美托咪定撤药症状的发生率。还评估了开始撤药后使用右美托咪定的时间以及药物成本差异。本研究共纳入42例患者：15例接受可乐定治疗（C组），27例单纯停用右美托咪定（D组）。两组中出现两种或更多撤药症状的发生率无显著差异（C组为73%，D组为59%；P = 0.51）。与D组患者相比，C组患者开始撤药后使用右美托咪定的时间更短（19小时对42小时；P = 0.02）。观察到接受可乐定治疗的患者平均每人节省成本1553.47美元。未观察到不良反应。
我们的研究表明，与单纯停用右美托咪定的患者相比，接受可乐定治疗的患者能够更快地停用右美托咪定，节省了可观的成本，且右美托咪定撤药症状无差异。可乐定可能是帮助患者从长期右美托咪定输注过渡停药的一种安全、有效且实用的选择。
