217 Does Clonidine have an Antipyretic Effect in Pediatric Burn Patients?

• Published in: Journal of burn care & research 2018-04, Vol.39 (suppl_1), p.S75-S75
• Main Authors: Hursey, D, Song, D, Sheridan, R L
• Format: Article
• Language: English
• ISSN: 1559-047X; 1559-0488
• DOI: 10.1093/jbcr/iry006.139

Abstract Introduction Fever management with antipyretics in acutely ill patients after source identification is limited to acetaminophen or NSAIDs. However, the potential antipyretic effect of clonidine in critically ill adults has been described in the literature. Animal research has demonstrated mild hypothermia and decreased febrile response. The mechanism of action is believed to be mediated through agonizing the alpha-2 adrenoceptor located in the hypothalamus. Clonidine is used at our institution for narcotic and sedative withdrawal management. In this retrospective cohort study, we reviewed the effects of clonidine on fever response in our pediatric burn population to determine utility as a third line antipyretic. Methods Thirty-six patients aged 0–18 years, acutely admitted to our institution for burn injury from January 2012 to August 2016 who received enteral clonidine for at least 7 consecutive days during their admission were included. Each identified patient was matched for age and total burn surface area (TBSA) to a patient not treated with clonidine. Primary endpoints were total number of febrile events (≥38.3°C) and daily average maximum body temperature during that 7 day period. Secondary endpoints included total doses of antipyretics administered and doses of clonidine held. Data was collected on potential confounders including length of stay (LOS), positive blood cultures and antibiotic days. Data are presented as means (± standard deviation). Comparisons are made using Student’s t-test. Results Eighteen patients were treated with clonidine during the study period. Table 1 shows baseline subject characteristics. There was no significant difference in total number of febrile events 32.2 ± 40.3 vs. 22.7 ± 36.1 (p>0.05). Non-significance was maintained for all days studied. There was no significant difference in daily average maximum body temperature 38.0 ± 1.5 vs. 38.2 ± 0.8 (p>0.05) or total antipyretic doses 12.9 ± 11.3 vs. 10.2 ± 11 (p>0.05) used during the 7 days. There were a total of 5 clonidine doses held for all subjects (1.7%), 2 for hypotension and 3 for surgical operation. Conclusions Preliminary data suggests clonidine administered to acute pediatric burn patients does not have a significant effect in decreasing total febrile events, lowering the daily maximum body temperature or decreasing total antipyretic doses used. Applicability of Research to Practice In our study design and population, clonidine does not appear to provid