Continuous dexmedetomidine infusion may induce fever in ICU patients

Infusion of dexmedetomidine for 72 h and infusion rate at ≥1 mcg/kg/h appear to contribute to the development of fever in critically ill patients in a community teaching hospital, suggests a study.

“Drug-induced fevers are usually a diagnosis of exclusion, making them hard to recognize, and misdiagnosis can lead to utilization of additional medications and resources,” the authors said.

Eighty-one adult patients, admitted to the intensive care unit (ICU), who received at least 12 h of continuous dexmedetomidine infusion were included in this single-centre retrospective study conducted at a 464-bed community teaching hospital.

The authors identified risk factors for dexmedetomidine-related fever by conducting univariate and multivariate logistic regression analyses.

Of the patients receiving dexmedetomidine infusion, 31 (38.3 percent) were febrile and 50 (61.7 percent) were afebrile.

In multivariate analysis, patients who received dexmedetomidine continuously for ≥72 h had an increased likelihood of developing fever (odds ratio [OR], 5.97, 95 percent confidence interval [CI], 1.90‒18.75). Likewise, a dexmedetomidine rate of ≥1 mcg/kg/hr at Tmax was associated with fever development (OR, 6.16, 95 percent CI, 1.80‒21.09).

“The Society of Critical Care Medicine’s 2025 update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption suggests the use of dexmedetomidine over propofol for sedation in critically ill, mechanically ventilated patients,” the authors said.

“With widespread use of dexmedetomidine, reports have been published describing development of fever with its use,” they added.