Abstract
Objective. To summarize clinical research related to the effect of clonidine on sedation, signs
and symptoms of withdrawal, and other adverse events among mechanically ventilated
children.
Data Sources. We searched MEDLINE, EMBASE, CINAHL, LILACS and the Cochrane Central Register of
Controlled Trials, trial registries and conference proceedings.
Study Selection. We included all observational and experimental studies that reported the transdermal,
intravenous or enteral administration of clonidine to mechanically ventilated, critically
ill pediatric patients.
Data Extraction. We extracted data on the effect of clonidine on sedation, withdrawal, duration of
ventilation and adverse effects and did not attempt to quantitatively combine the
results due to the heterogeneous study design and patient populations.
Data Synthesis. This review includes 4 case reports, two retrospective cohort studies (total of
58 children), two prospective uncontrolled studies (total of 55 children) and one
randomized controlled trial (69 children). In general, efforts to minimize known sources
of bias were modest and all studies used non-validated tools for measuring withdrawal.
Small observational studies suggest an improvement in withdrawal symptoms and adequacy
of sedation with clonidine therapy; however, the small randomized trial found no effect
on these or on the duration of ventilation. Results of these small studies have limited
generalizability and provide imprecise estimates of treatment effects.
Conclusions. Clonidine has been used as a sedative and analgesic agent to prevent and treat withdrawal
in critically ill intubated children. Current clinical studies are inadequate to assess
its benefits and harms, and do not support current widespread use.
Keywords
Sedation - clonidine - child - critical illness - mechanical ventilation - systematic
review
