Incidence of Fever Associated With Dexmedetomidine in the Adult Intensive Care Unit

Abstract

Background: Published literature has described the temporal relationship of dexmedetomidine with elevated temperatures, but there is limited data to quantify the incidence of fever in ICU patients receiving dexmedetomidine. Objective: The primary objective of this study was to estimate the incidence of temperature greater than or equal to 38.5°C in ICU patients receiving dexmedetomidine. Methods: This was a retrospective cohort study of ICU patients who received dexmedetomidine with a propensity-matched subgroup analysis comparing dexmedetomidine fever patients to non-fever patients. Patients 18 years of age and older admitted between November 2017 and August 2018 who received continuous dexmedetomidine for 6 or more hours were eligible for inclusion. Included patients with a temperature of great than or equal to 38.5°C while receiving dexmedetomidine were established as having dexmedetomidine-related fever. Results: Of 882 eligible ICU patients, 404 dexmedetomidine patients were included in the study. Sixty-one patients (15.1%) met the definition for the primary endpoint. Forty-two patients who received dexmedetomidine but experienced no fever were matched for multivariate analysis. The fever group received a higher mean maximum infusion rate (0.98 µg/kg/h ± 0.43 vs. 0.68 µg/kg/h ± 0.42, P < 0.001) and a longer median duration of dexmedetomidine (43.0 hours [range 7-711] vs. 24.3 hours [6-148], P = 0.001) compared to the non-fever group. Conclusion: Fever greater than 38.5°C was observed in 15.1% of ICU patients while receiving dexmedetomidine. Prospective studies are warranted to validate these findings.

More than Drug Fever: Dexmedetomidine-Induced Hyperthermia in a Critically Ill Patient

“…9 In a retrospective cohort study of adult ICU patients across two tertiary hospitals, 15.1% of patients that received six or more hours of dexmedetomidine continuous infusions had at least one temperature greater than or equal to 38.5°C. 6 The mean maximum temperature of these patients was 38.9°C with a mean time from dexmedetomidine initiation to fever onset of 26.5 hours. In a retrospective cohort study across medical and surgical ICUs at a single institution, patients exposed to dexmedetomidine had a strong association for temperatures ≥103.1°F (39.5°C) compared to patients not exposed to dexmedetomidine (OR: 4.5; CI: 3.4, 5.9; P < .001).…”

“…[2][3][4] As the clinical use of dexmedetomidine has increased with the drug becoming generic, recent reports have associated dexmedetomidine with low-grade fever. 5,6 Here, we present the case of severe hyperthermia that developed within hours of initiating dexmedetomidine infusion in a critically ill patient.…”

Evaluation of Dexmedetomidine’s Effect on Temperature in Obese Critically Ill Patients

“…Recent case series, case reports, and a post hoc analysis have all suggested a link between dexmedetomidine use and hyperthermia. 5,6,[8][9][10][11][12][13] A post hoc analysis of the patients included in the Sedation Practice in Intensive Care Evaluation (SPICE) III study showed that over the first 5 ICU days more patients had a temperature greater than or equal to 38.3°C in the dexmedetomidine group compared to the usual care group (43.3% vs 32.7%; P = .004). 9,14 There was no difference found in the mean daily temperature between the dexmedetomidine group vs the usual care group (36.84°C vs 36.78°C; P = .16); however, this study found a significant difference in the highest daily temperature between the dexmedetomidine group and the usual care group (37.41°C vs 37.29°C; P = .01).…”