Dexmedetomidine-induced fever and delirium: A case report

Straw, L. B.; Dodson, C. R.; Schrift, David

doi:10.1111/jcpt.12680

Cited by 11 publications

(13 citation statements)

References 14 publications

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“…Study characteristics including quality of evidence and risk of bias are summarized in Table 2 8,23–38 . The majority of reports were case reports/series with few retrospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

“…Much of the literature for use of dexmedetomidine in critically ill patients focuses on reducing the incidence of delirium or treating new‐onset delirium 43 . The case presented by Straw et al of a 41‐year‐old woman with acute respiratory distress syndrome is interesting, as they described dexmedetomidine‐induced fever and delirium, with Naranjo scores of 8 and 7, respectively 37 . It is possible that the dexmedetomidine‐induced fever led to the agitated delirium observed in their case, as fever is a common culprit for causing delirium.…”

Section: Discussionmentioning

confidence: 99%

“…Study characteristics including quality of evidence and risk of bias are summarized in Table 2. 8,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] The majority of reports were case reports/series with few retrospective cohort studies. There were no high-quality randomized, controlled trials identified through systematic review.…”

Section: Study Characteristics and Qualitymentioning

confidence: 99%

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Fever Associated With Dexmedetomidine in Adult Acute Care Patients: A Systematic Review of the Literature

Schurr

Ambrosi

Lastra

et al. 2021

The Journal of Clinical Pharma

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Dexmedetomidine‐associated fever has been reported in the literature and can lead to lengthy workups and unnecessary antibiotic exposure. We conducted a systematic review to evaluate and describe the evidence of fever or hyperthermia caused by dexmedetomidine in adult patients. Data sources included PubMed/MEDLINE, EMBASE, CINAHL, and Web of Sciences. English‐language studies of any design published from inception through April 2020 including conference abstracts were included. The target population was hospitalized adult patients. Quality of evidence was determined based on GRADE recommendations and risk of bias assessed using the Evidence Project Risk of Bias tool. Naranjo scores were assessed to determine the likeliness of adverse event being caused by dexmedetomidine. All data were extracted independently and with the guidance of a medical librarian. Four hundred and eighty‐eight total citations were found on formal search, with 329 left after removal of duplicates. Independent record screening was performed, leaving 17 citations including 4 retrospective cohort studies, 1 case series, and 12 case reports. Quality of evidence ranged from very low to low for identified analyses. Evidence with patient‐level data (case reports and series) were combined to establish a cohort for descriptive results. The median Naranjo score was 4 (range, 3 to 8), and dexmedetomidine doses ranged from 0.1 to 2 μg·h/kg. Obesity and cardiac surgery appear to be significant risk factors. Dexmedetomidine‐associated fever appears uncommon, but the true incidence is unknown. Clinicians should keep dexmedetomidine‐associated fever in their differential, and stewardship programs should consider assessing for this adverse effect in their patient monitoring.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristics and Qualitymentioning

confidence: 99%

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Fever Associated With Dexmedetomidine in Adult Acute Care Patients: A Systematic Review of the Literature

Schurr

Ambrosi

Lastra

et al. 2021

The Journal of Clinical Pharma

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“…The Naranjo method, an algorithm to assess the likelihood of an adverse drug reaction, was used to determine whether the lipid emulsion was the cause of hypertension [ 7 , 8 ]. The Naranjo method yielded a probability score of + 10, suggesting that the lipid emulsion was the perpetrator of the adverse hypertension (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Lipid emulsion-induced hypertension post resection of pediatric neuroblastoma: a case report and literature review

Yuan

et al. 2022

BMC Pediatr

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Background Parenteral Nutrition (PN) is preferred when patient is unable to eat. Most clinically widely used lipid emulsion is now attracting more attention in its stability and adverse reactions. We report here the first case of lipid emulsions caused hypertension. Case presentation A 1.5 years old girl was diagnosed with neuroblastoma and underwent chemotherapy subsequently followed by resection surgery. She received PN for nutritional support after surgery. with the initiation of PN, this patient developed hypertension. Possible causes of hypertension were evaluated. After the discontinuation of lipid emulsions in PN, her hypertensive symptoms ceased. The lipid emulsion was therefore considered as the cause of her hypertension. Conclusions The pathogenesis of hypertension caused by fatty milk is possibly associated with increased production of reactive oxygen species, increased oxidative stress and vasoconstriction.

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“…5-7 This shift in clinical practice along with the decreasing cost of dexmedetomidine has led to an increase in use of this agent and reported cases of drug fever. 1 , 8-12…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Characterization of Dexmedetomidine-Suspected Fever and Its Consequences in Adult Critically Ill Patients

et al. 2022

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Background: Current evidence for dexmedetomidine-suspected fever (DSF) is limited. Lack of recognition may lead to costly or potentially harmful interventions for critically ill patients. Objective: The primary objective was to characterize escalations of care related to DSF. Secondary objectives were to describe the incidence, severity, and consequences associated with DSF. Methods: A retrospective review was conducted in critically ill adults who developed fever ≥39°C within 12 h from initiation of dexmedetomidine, with resolution of fever to <39°C within 12 h after discontinuation. The primary outcome was percentage of patients who received an escalation of care due to fever. Secondary outcomes included the percentage of patients who developed a multidrug-resistant organism or Clostridium difficile infection. Results: Eighteen of 3943 patients screened in 4099 encounters met criteria for DSF (0.4%). The majority were white (83.3%), male (66.7%), and underwent cardiac surgery (61.1%). Median (interquartile range [IQR]) time to fever onset and resolution were 5.5 (3.6-7.6) and 1.3 (1.0-2.9) h. Nine patients (50%) underwent infectious workup including antimicrobial initiation (n = 1, 5.6%), broadening of antimicrobials (n = 4, 22.2%), or culture collection (n = 9, 50%). Eleven patients (61.1%) underwent attempted temperature reduction. Twelve patients (66.7%) underwent diagnostic imaging. Incidence of multidrug-resistant organism and C. difficile infection were low (11.1 and 16.7% of fever patients, respectively). Conclusion and Relevance: Incidence of DSF was low and more common in cardiac surgery patients. Unrecognized DSF led to an escalation of care in most patients. Dexmedetomidine exposure should be considered as a potential cause of fever in critically ill adults.

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Dexmedetomidine-induced fever and delirium: A case report

Abstract: We depict the first known case of dexmedetomidine causing high fevers and delirium.

Cited by 11 publications

References 14 publications

Fever Associated With Dexmedetomidine in Adult Acute Care Patients: A Systematic Review of the Literature

Fever Associated With Dexmedetomidine in Adult Acute Care Patients: A Systematic Review of the Literature

Lipid emulsion-induced hypertension post resection of pediatric neuroblastoma: a case report and literature review

A Retrospective Characterization of Dexmedetomidine-Suspected Fever and Its Consequences in Adult Critically Ill Patients

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