Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA.
Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Clin Pharmacol. 2021 Jul;61(7):848-856. doi: 10.1002/jcph.1826. Epub 2021 Mar 3.
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.
地塞米松相关发热已在文献中报道，并可能导致冗长的检查和不必要的抗生素暴露。我们进行了系统评价，以评估和描述地塞米松引起的成年患者发热或体温升高的证据。数据来源包括 PubMed/MEDLINE、EMBASE、CINAHL 和 Web of Sciences。纳入了从最初发表到 2020 年 4 月的任何设计的英语研究，包括会议摘要。目标人群为住院成年患者。根据 GRADE 建议确定证据质量，并使用 Evidence Project 偏倚风险工具评估偏倚风险。评估 Naranjo 评分以确定不良事件是否由地塞米松引起。所有数据均独立提取，并在医学图书馆员的指导下进行。正式检索共发现 488 条引文，去除重复项后剩余 329 条。独立记录筛选后，留下 17 条引文，包括 4 项回顾性队列研究、1 项病例系列和 12 项病例报告。确定分析的证据质量从极低到低不等。具有患者水平数据（病例报告和系列）的证据合并为一个队列，用于描述性结果。中位数 Naranjo 评分为 4（范围 3 至 8），地塞米松剂量为 0.1 至 2 μg·h/kg。肥胖和心脏手术似乎是显著的危险因素。地塞米松相关发热似乎不常见，但真实发生率尚不清楚。临床医生应将地塞米松相关发热纳入鉴别诊断，管理计划应考虑在患者监测中评估这种不良反应。
