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- Title
Clonidine for sedation in the critically ill: a systematic review and meta-analysis.
- Authors
Wang, Jing Gennie; Belley-Coté, Emilie; Burry, Lisa; Duffett, Mark; Karachi, Timothy; Perri, Dan; Alhazzani, Waleed; D'Aragon, Frederick; Wunsch, Hannah; Rochwerg, Bram
- Abstract
<bold>Background: </bold>This systematic review and meta-analysis investigates the efficacy and safety of clonidine as a sedative in critically ill patients requiring invasive mechanical ventilation.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Publication
Critical Care, 2017, Vol 21, p1
- ISSN
1364-8535
- Publication type
journal article
- DOI
10.1186/s13054-017-1610-8