Dexmedetomidine Suspected Fever and Clinical Escalation: A Pilot Study Evaluating the Impact in the Intensive Care...

Dexmedetomidine, an alpha-2 agonist commonly used as a sedative agent in mechanically ventilated patients, has been associated with drug-induced fever. Concern for fever may prompt diagnostic evaluation and empiric antimicrobial therapy, potentially leading to unnecessary health care utilization.

This pilot study aimed to evaluate if dexmedetomidine use in mechanically ventilated medical intensive care unit (ICU) patients was associated with increased escalation of care compared with alternate sedative agents.

This single-center, retrospective, matched cohort study included patients 18 years or older who were admitted to the medical ICU and required a sedative agent to facilitate mechanical ventilation. Patients receiving dexmedetomidine were matched 1:1 with patients receiving alternate sedative agents. The primary outcome was the composite outcome of initiation of diagnostic evaluation and/or antimicrobial escalation (IDEA).

A total of 150 patients were included (75 per group). Most patients were male (68%), and 45% had a primary diagnosis of respiratory failure. The primary outcome, IDEA, occurred in 53 patients (71%) receiving dexmedetomidine and 51 patients (68%) receiving alternate sedatives (P = .723). Fever occurred in 24 patients (32%) receiving dexmedetomidine compared with 17 patients (23%) receiving alternate sedatives. Median ICU length of stay was longer in the dexmedetomidine group (5 [interquartile range, IQR 1-8] vs 4 [IQR 1-5] days; [P = .002]). In-hospital mortality occurred in 14 patients (19%) receiving dexmedetomidine and 24 patients (32%) receiving alternate sedative (P = .060).

There was no statistically significant difference between escalation of care in the use of dexmedetomidine versus other sedatives in ICU patients.