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P133 Use of continuous infusion of clonidine for sedation in critically ill children: indications, efficacy and side effects.
Although numerous PK/PD data from various in vitro and in vivo experimental studies favor the use of continuous infusion, the current clinical data are less convincing and insufficient to instigate a global shift from conventional bolus dosing.
Such a result strongly supports the use of continuous infusion, and since this administration mode provides a better outcome than intermittent infusion [24], we believe a 16-g daily dose given as a continuous infusion, following a 4.5-g loading dose, should be considered as a starting point in ICU patients with normal renal function.
The use of continuous infusion LD has attracted tremendous attention.
Ten ICUs reported the use of continuous infusion, varying from 10too 100 μg/ hour, median 50 μg/hour.
[ 7] The use of continuous infusion sedation is associated with prolongation of mechanical ventilation, longer ICU stays and longer hospital stays [ 11].
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Treatment characteristics, specifically higher daily benzodiazepine and opioid doses, use of antipsychotics, and the use of continuous infusions of analgo-sedation were predictors of PR use.
Consideration should be given to reduced dosing intervals or the use of continuous infusions guided by appropriate monitoring, to ensure therapeutic plasma levels.
Additionally, prolonged use of continuous infusions of analgesics and sedatives results in accumulation of these drugs as well as their active metabolites leading to over-sedation, greater hemodynamic instability, and prolonged mechanical ventilation and ICU stay [ 11].
Strategies to limit the amount of sedation in critically ill patients, either by performing a daily interruption [ 13], or by minimizing the use of continuous infusions [ 14] reduce time on mechanical ventilation without causing harm.
To overcome these problems, several authors have employed different methods to deliver a more suitable sedation regimen, such as goal-directed sedation [ 13]; daily interruption [ 5]; protocolized, nurse-driven sedation [ 14]; and minimized use of continuous infusions [ 6, 15].
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