LAUSR

Learning Objectives: The safety and effectiveness of transitioning from dexmedetomidine (DEX) to enteral clonidine (CLON) in adults for ICU sedation has been described in small cohorts. The purpose of this study was to expand upon these reports in a larger sample of adult ICU patients. Methods: This retrospective study analyzed consecutive ICU patients ≥18 years of age transitioned from DEX to CLON from April 1, 2014-June 1, 2015. The transition was assessed in 5 phases: DEX alone, transition, CLON alone, CLON taper, and post-CLON. Safety data included incidence of bradycardia, hypotension, new second or third degree atrioventricular block, CLON withdrawal, and continuation of CLON at discharge with plan to discontinue on hospital discharge. Efficacy data included transition to CLON alone within 24 and 48 hours of CLON initiation, re-initiation of DEX, and daily doses of concomitant analgesic, anxiolytic, and psychoactive medications. Continuous variables were reported as medians with interquartile 25–75% range and compared with paired t-test. Categorical variables were recorded as percentages and compared with χ2 test. Results: 62 patients were included with a median age of 54 (45,65) years, 66% were male, median APACHE II score was 17 (15,23). Median DEX dose at time of CLON initiation was 0.8 (0.5, 1.4) mcg/kg/hr. The median initial and maintenance CLON dose was 0.3 mg q6h. Transition from DEX to CLON was successful within 24 and 48 hours in 44% and 65% of patients, respectively. Median transition duration was 28 (11,52) hours. CLON withdrawal was seen in 3 (5%) patients and 6 (10%) were discharged on CLON without a plan to discontinue. The incidence of any adverse event for DEX alone vs CLON alone was (64% vs 31%, p=<0.001). Fentanyl-equivalents were lower during CLON alone vs DEX alone (409 vs 1149 mcg/day, p=<0.001), but lorazepam equivalents were similar (2.9 vs 5.3 mg/day, p=0.19). DEX was restarted in 12 (19%) patients, occurring more commonly if concomitant medications (propofol, phenobarbital, or valproate) were required during DEX alone (39% vs 11%, p=0.01) or during the transition (40% vs 9.5%, p=<0.01). Time to transition to CLON as the sole alpha-2 agonist remained the same with or without concomitant medication during DEX alone and transition phases. Conclusions: Transition from DEX to CLON in adult ICU patients may be a safe and effective way of providing ongoing alpha-2 agonist therapy. A comparative study is necessary to confirm these findings and demonstrate any benefits.