885

Abstract

Introduction: The degree of withdrawal symptoms after discontinuation of dexmedetomidine is not well described. The primary objective of this study was to compare withdrawal symptoms among patients on clonidine to those not on clonidine, while being weaned from long term dexmedetomidine. Methods: This was a single center retrospective analysis in an academic institution from 2009-2012. All patients ≥2 weeks old, ≥42 weeks gestational age, and ≤18 years old who were admitted to the pediatric intensive care unit (PICU), intubated for acute respiratory failure, and received dexmedetomidine as a continuous infusion for ≥ 5 days were included. Exclusion criteria included: patients with cyanotic heart disease, primary pulmonary hypertension, ventilator dependent on PICU admission, and status post cardiovascular surgical repair. The primary outcome of withdrawal was assessed by the number of Withdrawal Assessment Tool (WAT) scores ≥3 during the 24 hours post-wean. Secondary outcomes included the incidence of rebound hypertension and rebound tachycardia during the 24 hours post-wean. Rebound hypertension and rebound tachycardia were defined as an increase of 20% or more compared to the pre-wean time period. Results: Nineteen patients (median age 1.5 years, IQR 0.67-3.3) received 20 treatment courses of dexmedetomidine for at least 5 days and met inclusion criteria. Clonidine was received by patients during 12 of the treatment courses. The patients in the clonidine group had a mean of 0.8 (range 0-6) elevated WAT scores compared to a mean of 3.2 (range 0-8) elevated WAT scores in the no clonidine group (p = 0.149). There were no significant differences between pre-wean and post-wean systolic or diastolic blood pressures among the two groups. The mean heart rate during the post-wean period was 112 (range 88.5-151.5) in the clonidine group compared to 138.4 (range 117.8-168.3) in the no clonidine group (p = 0.003). Conclusions: Patients who received clonidine while being weaned from long term dexmedetomidine trended towards fewer elevated WAT scores during the 24 hours post dexmedetomidine wean and had significantly less tachycardia.