Does acetaminophen (paracetamol) work on ICU patients?

Show him death and he will be content with fever. – Persian proverb.

Background

Acetaminophen (paracetamol) is a common therapy for fever in ICU patients with probable infection, but the effects are unknown.

Method

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.

Conclusion

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

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