Clonidine for sedation in the critically ill: a systematic review and meta-analysis
Background This systematic review and meta-analysis investigates the efficacy and safety of clonidine as a sedative in critically ill patients requiring invasive mechanical ventilation. Methods 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. Results 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, I2 = 86%, moderate certainty), ICU mortality (relative risk (RR) 0.98, 95% CI = 0.51 to 1.90, I2 = 0%, low certainty), or ICU length of stay (MD 0.04 days, 95% CI = -0.46 to 0.53, I2 = 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, I2 = 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, I2 = 0%, moderate certainty). Conclusions 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..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:21 |
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| Enthalten in: |
Critical care - 21(2017), 1 vom: 25. Feb. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wang, Jing Gennie [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| Themen: |
Clonidine |
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| Anmerkungen: |
© The Author(s). 2017 |
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| doi: |
10.1186/s13054-017-1610-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
SPR029897262 |
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| 520 | |a Background This systematic review and meta-analysis investigates the efficacy and safety of clonidine as a sedative in critically ill patients requiring invasive mechanical ventilation. Methods 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. Results 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, I2 = 86%, moderate certainty), ICU mortality (relative risk (RR) 0.98, 95% CI = 0.51 to 1.90, I2 = 0%, low certainty), or ICU length of stay (MD 0.04 days, 95% CI = -0.46 to 0.53, I2 = 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, I2 = 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, I2 = 0%, moderate certainty). Conclusions 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. | ||
| 650 | 4 | |a Clonidine |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Systematic review |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Sedation |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Delirium |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Mechanical ventilation |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Weaning |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Belley-Coté, Emilie |4 aut | |
| 700 | 1 | |a Burry, Lisa |4 aut | |
| 700 | 1 | |a Duffett, Mark |4 aut | |
| 700 | 1 | |a Karachi, Timothy |4 aut | |
| 700 | 1 | |a Perri, Dan |4 aut | |
| 700 | 1 | |a Alhazzani, Waleed |4 aut | |
| 700 | 1 | |a D’Aragon, Frederick |4 aut | |
| 700 | 1 | |a Wunsch, Hannah |4 aut | |
| 700 | 1 | |a Rochwerg, Bram |4 aut | |
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