Intensive Care Medicine

, Volume 35, Issue 2, pp 275–281

Respiratory, metabolic and hemodynamic effects of clonidine in ventilated patients presenting with withdrawal syndrome

  • Domniki Liatsi
  • Basilis Tsapas
  • Smaro Pampori
  • Matthew Tsagourias
  • Ioannis Pneumatikos
  • Dimitrios Matamis
Original

DOI: 10.1007/s00134-008-1251-0

Cite this article as:
Liatsi, D., Tsapas, B., Pampori, S. et al. Intensive Care Med (2009) 35: 275. doi:10.1007/s00134-008-1251-0

Abstract

Objective

To investigate the respiratory, metabolic and hemodynamic effects of clonidine in ventilated patients presenting with withdrawal syndrome after sedation interruption.

Design

Prospective, interventional, single-center study in 30 ventilated ICU patients.

Interventions

Metabolic [oxygen consumption (VO2), CO2 production (VCO2), resting energy expenditure (REE)], respiratory [minute ventilation (VE), tidal volume (VT), respiratory rate (RR)] and hemodynamic (HR, SAP, MAP) parameters were measured in 30 ventilated ICU patients. Measurements were performed first under sedation with remifentanil–propofol, then after sedation interruption, and finally after clonidine administration (0.9–1.8 mg of clonidine in two doses of 10 min interval).

Results

Sedation interruption produced significant increases in the hemodynamic parameters (SAP and MAP by 33%, HR by 37%), and metabolic rate (increase in VO2 by 70%, VCO2 by 88% and REE by 74%), leading to high respiratory demands (increase in VE from 9 to 15 l/min). The VE was increased due to a twofold increase in the RR; VT remained constant. In 25 out of 30 patients, clonidine administration decreased the hemodynamic (SAP, MAP and HR), metabolic (VO2, VCO2, REE) and respiratory parameters to values close to those observed with sedation. Clonidine induced mild sedation and patients became more cooperative with the ventilator. All patients responding to clonidine were weaned from the ventilator in 2 days (median, range 1–18 days).

Conclusion

Patients with withdrawal syndrome had significantly elevated hemodynamic, metabolic and respiratory demands. Clonidine significantly decreased these demands, induced mild sedation and facilitated patient cooperation with the ventilator, enabling ventilator weaning.

Keywords

ClonidineWithdrawal syndromeWeaning from mechanical ventilationHemodynamic effectsMetabolic effectsRespiratory effectsSedation

Supplementary material

134_2008_1251_MOESM1_ESM.tif (1.5 mb)
Fig. 3 Systolic (SAP), mean systemic artery pressure (MAP) and heart rate (HR) during sedation, sedation interruption and after clonidine treatment. Values of Y-axis represent mmHg for SAP and MAP, and beats/min for HR (mean values and SEM). Asterisks indicate statistically significant differences by post-hoc analysis, between no sedation and the other two conditions. No significant difference was found between sedation and after clonidine administration (TIF 1.49 mb)
134_2008_1251_MOESM2_ESM.tif (1.5 mb)
Fig. 4 Respiratory rate (RR), minute ventilation (VE) and tidal volume (VT) during sedation, sedation interruption and after clonidine treatment. Values of Y-axis represent l/min for VE, liter for VT, and breaths/min for RR (mean values and SEM). Asterisks indicate statistically significant differences by post-hoc analysis between no sedation and the other two conditions. No significant difference was found between sedation and after clonidine administration (TIF 1.47 mb)
134_2008_1251_MOESM3_ESM.tif (1.5 mb)
Fig. 5 O2 consumption (VO2), CO2 production (VCO2) and resting energy expenditure (REE)/REEpredicted during sedation, sedation interruption and after clonidine treatment. Values of Y-axis represent ml/min for VO2 and VCO2 and % for REE/REEpredicted (mean values and SEM). Asterisks indicate significant differences by post hoc analysis between no sedation and the two other conditions. No significant difference was found between sedation and after clonidine administration (TIF 1.53 mb)

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Domniki Liatsi
    • 1
  • Basilis Tsapas
    • 1
  • Smaro Pampori
    • 1
  • Matthew Tsagourias
    • 1
  • Ioannis Pneumatikos
    • 2
  • Dimitrios Matamis
    • 1
  1. 1.ICUPapageorgiou General HospitalThessalonikiGreece
  2. 2.ICUAlexandroupolis University HospitalDraganaGreece