The Effect of Early Sedation With Dexmedetomidine on Body Temperature in Critically Ill Patients.

Abstract

OBJECTIVES:

Previous case series reported an association between dexmedetomidine use and hyperthermia. Temperature data have not been systematically reported in previous randomized controlled trials evaluating dexmedetomidine. A causal link between dexmedetomidine administration and elevated temperature has not been demonstrated.

DESIGN:

Post hoc analysis.

SETTING:

Four ICUs in Australia and New Zealand.

PATIENTS:

About 703 mechanically ventilated ICU patients.

INTERVENTIONS:

Early sedation with dexmedetomidine versus usual care.

MEASUREMENTS AND MAIN RESULTS:

The primary outcome was mean daily body temperature. Secondary outcomes included the proportions of patients with body temperatures greater than or equal to 38.3°C and greater than or equal to 39°C, respectively. Outcomes were recorded for 5 days postrandomization in the ICU. The mean daily temperature was not different between the dexmedetomidine (n = 351) and usual care (n = 352) groups (36.84°C ± sd vs 36.78°C ± sd; p = 0.16). Over the first 5 ICU days, more dexmedetomidine group (vs usual care) patients had a temperature greater than or equal to 38.3°C (43.3% vs 32.7%, p = 0.004; absolute difference 10.6 percentage points) and greater than or equal to 39.0°C (19.4% vs 12.5%, p = 0.013; absolute difference 6.9 percentage points). Results were similar after adjusting for diagnosis, admitting temperature, age, weight, study site, sepsis occurrence, and the time from dexmedetomidine initiation to first hyperthermia recorded. There was a significant dose response relationship with temperature increasing by 0.30°C ±0.08 for every additional 1 μg/kg/hr of dexmedetomidine received p < 0.0002.

CONCLUSIONS:

Our study suggests potentially important elevations in body temperature are associated with early dexmedetomidine sedation, in adults who are mechanically ventilated in the ICU.

• Authors: Kim E Grayson, Michael Bailey, Mayurathan Balachandran, Piyusha P Banneheke, Alessandro Belletti, Rinaldo Bellomo, Thummaporn Naorungroj, Ary Serpa-Neto, Jason D Wright, Fumitaka Yanase, Paul J Young, Yahya Shehabi
• Journal: Critical care medicine (Crit Care Med) Vol. 49 Issue 7 Pg. 1118-1128 (07 01 2021) ISSN: 1530-0293 [Electronic] United States
• PMID: 33729724 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Chemical References

• Hypnotics and Sedatives
• Dexmedetomidine

Topics

• Aged
• Body Temperature (drug effects)
• Critical Illness (therapy)
• Dexmedetomidine (adverse effects, pharmacology)
• Dose-Response Relationship, Drug
• Female
• Humans
• Hyperthermia (chemically induced)
• Hypnotics and Sedatives (adverse effects, pharmacology)
• Male
• Middle Aged
• Respiration, Artificial
• Time Factors