Kim E Grayson1, Michael Bailey2,3, Mayurathan Balachandran4, Piyusha P Banneheke4, Alessandro Belletti5,6, Rinaldo Bellomo2,3,5,7, Thummaporn Naorungroj7,8, Ary Serpa-Neto2,5,9, Jason D Wright1, Fumitaka Yanase2,7, Paul J Young1,10, Yahya Shehabi4,11,12. 1. Intensive Care Unit, Wellington Hospital, Wellington, New Zealand. 2. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia. 3. University of Melbourne, Parkville, VIC, Australia. 4. Monash University, School of Clinical Sciences, Clayton, VIC, Australia. 5. Data Analytics Research and Evaluation Centre, Austin Hospital and University of Melbourne, Melbourne, VIC, Australia. 6. Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. 7. Intensive Care Unit, Austin Hospital, Heidelberg, VIC, Australia. 8. Intensive Care, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 9. Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. 10. Medical Research Institute of New Zealand, Wellington, New Zealand. 11. Intensive Care Unit, Monash Medical Centre, Clayton, VIC, Australia. 12. University of New South Wales, Prince of Wales Clinical School of Medicine, Randwick, NSW, Australia.
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.
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: Daniel B Knox; Alex Brunhoeber; Ithan D Peltan; Samuel M Brown; Michael J Lanspa Journal: Intensive Care Med Date: 2022-08-05 Impact factor: 41.787