Risk Factors for the Development of Dexmedetomidine-Related Fevers in Critically-Ill Patients

Background: 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 suggest the use of dexmedetomidine over propofol for sedation in critically-ill, mechanically ventilated patients. With widespread use of dexmedetomidine, reports have been published describing development of fever with its use. 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 objective of this study was to identify risk factors associated with dexmedetomidine-related fever in critically-ill patients. Methods: This was a single-center retrospective study conducted at The Brooklyn Hospital Center, a 464-bed community teaching hospital. Adult patients, admitted to the intensive care unit, who received at least 12 hours of continuous dexmedetomidine infusion were included. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for dexmedetomidine-related fever. Results: Eighty one patients were included, of whom 31 (38.3%) were febrile and 50 (61.7%) were afebrile while receiving dexmedetomidine infusion. Multivariate analysis showed higher likelihood of developing fever if patients received dexmedetomidine continuously for ≥72 hours (OR 5.97, 95% CI 1.90-18.75) and if dexmedetomidine rate was ≥1 mcg/kg/hr at Tmax (OR 6.16, 95% CI 1.80-21.09). Conclusion: Dexmedetomidine infusion for 72 hours or longer and dexmedetomidine infusion rate at 1 mcg/kg/hr or greater were risk factors for developing a fever in critically ill patients in a community teaching hospital.