Acetaminophen (paracetamol) is a common therapy for fever in ICU patients with probable infection, but the effects are unknown.
This was a multi-centre (23 adult medical/surgical ICUs in NZ and Australia), prospective, randomised, double blinded controlled trial.
Seven hundred ICU patients with temp ≥38C and known or suspected infection received either 1g acetaminophen or placebo every 6 hours until ICU discharge, resolution of fever, cessation of antibiotics or death.
The primary outcome was ICU-free days (to day 28).
Results and discussion
There was no significant difference in ICU free days between acetaminophen and placebo (23 vs 22 days, p = 0.07).
There were no significant differences in 28 day (13.9% vs 13.7%, p=0.99) or 90 day mortality (15.9% vs 16.6%, p=0.73) between the two groups
In non-survivors, use of acetaminophen was associated with a significantly increased hospital and ICU length of stay (hospital LOS 13.9 vs 7.7 p<0.001; ICU LOS 10.4 vs 4.0 p<0.001). This leads to the question: does the use of acetaminophen to achieve normothermia delay death?
There was a statistically significant but clinically minor early reduction in maximum and mean temperature with acetaminophen.
Open label acetaminophen was used after ‘study medication course’ completed for a third of patients in both groups and this may have affected results.
The early use of IV acetaminophen in ICU patients with fever due to suspected infection results in a small reduction in temperature but it does not affect ICU free days.
Summary by Dr Anju Prasad