Sara Atyia, BCCCP, PharmD
The Ohio State University Wexner Medical Center East Hospital
Columbus
Disclosure information not submitted.
Anthony Gerlach, PharmD, FCCM
Clinical Pharmacist
Ohio State University Wexner Medical Center
Columbus, Ohio
Disclosure information not submitted.
Keaton Smetana, BCCCP, PharmD
Specialty Practice Pharmacist - Neurocritical Care
The Wexner Medical Center at The Ohio State University
Blacklick, Ohio
Disclosure information not submitted.
Molly Thompson, PharmD, BCCCP
Specialty Practice Pharmacist, Critical Care
The Ohio State University Wexner Medical Center, United States
Disclosure information not submitted.
Casey May, PharmD, BCCCP
Specialty Practice Pharmacist, Critical Care
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States
Disclosure information not submitted.
Title: Evaluation of Dexmedetomidine Dosing on Temperature in Obese Critically Ill Patients
Introduction: Previous literature showed an association between hyperthermia and dexmedetomidine (DEX) use for ICU sedation in non-obese patients. The purpose of this study is to evaluate DEX’s effect on body temperature in obese critically ill patients.
Methods: This single center, retrospective, cohort study included patients ³18 years, admitted to a surgical or medical ICU, received DEX for at least 8 hours as a single continuous infusion sedative, and weighed ≥120% of ideal body weight. Patients were excluded if they had a fever (³38°C) and positive cultures within 48 hours of DEX initiation. Temperature prior to DEX initiation, temperature maximum (Tmax) within 24 hours of DEX initiation, and Tmax at hours 24-48 after DEX initiation were evaluated. The primary endpoint was fever within 48 hours of DEX initiation. Statistical analyses were performed by Fisher’s exact test for nominal data presented as percentage or Mann-Whitney U-Test for nonparametric data presented as median [25-75% IQR].
Results: A total of 186 patients were included for evaluation. Forty-two patients (22.5%) had a fever during the first 48 hours of DEX. There was no difference in median weight between the groups (99.4 [90.6-122.4] vs 97.6 [81.6-114.2] kg, p=0.6). The median change from baseline temperature within 48 hours was 0.5 [0.1-0.8] °C, p< 0.001. Demographics were similar except median age (56 [45-63] vs 61 [49.5-68] years; p=0.028) was significantly lower in those that were febrile. While the median duration of DEX was significantly longer (48 [31-48] vs 34 [22-48] hours; p=0.03) in the febrile group, the median DEX dosage was similar (0.53 [0.32-0.68] vs 0.45 [0.28-0.7] mcg/kg/h, p=0.11). Significantly more patients in the febrile group received NSAIDs and/or acetaminophen (45.2% vs 11.8% p< 0.0001). In multiple regression analysis, duration of DEX and baseline temperature were significant predictors of development of fever with an adjusted odds ratio of 0.96 (95% CI 0.94-0.99, p=0.018) and 0.15 (95% CI 0.071-0.33, p< 0.001), respectively.
Conclusions: Our study suggests that there is a statistically significant increase in body temperature from baseline for obese patients on DEX. Duration of DEX and baseline temperature were found to be risk factors for development of fever in this population. Further studies are warranted.