Incidence of Fever Associated With Dexmedetomidine in Critically Ill Children

To evaluate the incidence of fever in critically ill pediatric patients receiving continuously infused dexmedetomidine.

This was a retrospective study of pediatric patients admitted to the pediatric or neonatal intensive care unit (PICU or NICU) between November 2017 and December 2021 who received dexmedetomidine. The primary endpoint was defined as a fever ≥38°C while receiving dexmedetomidine. Patient- and drug-specific characteristics between the fever and non-fever groups were compared to identify possible trends.

A total of 151 patients were included, with a median age of 15.8 months (IQR, 2.9-48.1). Thirteen patients (8.6%) met the criteria for the primary endpoint, with a mean maximum temperature of 38.2°C ± 0.2°C. Median time of fever onset was 9.7 hours (IQR, 2.0-29.3) into their dexmedetomidine infusion with a median dose of 0.4 mcg/kg/hr (IQR, 0.2-0.6). Patients within the fever group were younger (1.7 months [IQR, 1.1-8.6] vs 17.3 months [IQR, 3.3-65.5], p = 0.0006), reached a higher maximum infusion rate (0.8 mcg/kg/hr [IQR, 0.6-0.9] vs 0.6 mcg/kg/hr [IQR, 0.4-0.8], p = 0.0343), and received dexmedetomidine for longer durations (83.2 hours [IQR, 64.2-128.3] vs 35.2 hours [IQR, 17.6-55.7], p < 0.0001) than the non-fever group.

Fever ≥38°C was observed in 8.6% of PICU and NICU patients receiving dexmedetomidine. Younger patients or those exposed to higher doses or longer durations of dexmedetomidine may be at increased risk. Prospective studies will be required to further validate these findings.