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Crit Care Explor
. 2020 Sep 15;2(9):e0213.
doi: 10.1097/CCE.0000000000000213. eCollection 2020 Sep.
Dexmedetomidine-Associated Hyperpyrexia in Three Critically Ill Patients With Coronavirus Disease 2019
Kathryn S Czepiel 1 , Alexandra T Lucas 1 , Michael J Whalen 2 , James E Mojica 3
Affiliations
- PMID: 32984835
- PMCID: PMC7498133
- DOI: 10.1097/CCE.0000000000000213
Abstract
Objectives: To present three patients with severe coronavirus disease 2019 infection who developed life-threatening hyperpyrexia while being treated with dexmedetomidine for sedation.
Data sources: Clinical records.
Study selection: Case report.
Data extraction: Relevant clinical information.
Data synthesis: We describe three patients, a 60-year-old female, 43-year-old female, and 46-year-old male, who were hospitalized in surge ICUs during the coronavirus disease 2019 pandemic in the early spring of 2020. All developed hyperpyrexia, defined as a temperature above 41.1?C, following an increase in dexmedetomidine dosing to above 1.5 ?g/kg/hr. Fevers resolved following discontinuation of dexmedetomidine.
Conclusions: While the exact mechanism of hyperpyrexia remains unclear, findings in this study suggest that high doses of dexmedetomidine infusion are associated with hyperpyrexia in a seemingly dose-dependent fashion in critically ill patients with coronavirus disease 2019. Coronavirus disease 2019 infection causes a hyperinflammatory state characterized by pro-inflammatory cytokine dysregulation. Dexmedetomidine, a centrally acting alpha-2 agonist, may alter hypothalamic temperature regulation through disturbances in neurotransmitter expression and metabolism. We postulate that the use of high-dose dexmedetomidine in a hyperinflammatory state may increase the risk of developing hyperpyrexia in this severe disease state.
Keywords: COVID-19; coronavirus disease 2019; dexmedetomidine; hyperpyrexia; severe acute respiratory syndrome coronavirus 2.