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. 2010 Jun;25(2):363.e1-7.
doi: 10.1016/j.jcrc.2009.07.005. Epub 2009 Sep 24.

Acetaminophen has limited antipyretic activity in critically ill patients

Rachel S Greenberg  1 , Hegang Chen, Jeffrey D Hasday
Affiliations

Acetaminophen has limited antipyretic activity in critically ill patients

Rachel S Greenberg et al. J Crit Care. 2010 Jun.

Abstract

Purpose: Fever occurs commonly in the critically ill patients and may adversely affect outcome. Acetaminophen is one of the most commonly used antipyretic agents in the intensive care unit; however, there is little evidence that it is effective in this population. The objective of this study was to analyze the antipyretic activity of acetaminophen in critically ill patients.

Materials and methods: We performed a retrospective study of medical intensive care unit and surgical intensive care unit patients with systemic inflammatory response syndrome and compared the resolution of fever in the presence and absence of acetaminophen treatment by comparing the absolute reduction in body temperature and the rate of cooling over comparable time frames in fevers that were untreated and those treated with acetaminophen.

Results: We analyzed 166 febrile episodes (body temperature, >38 degrees C) in 59 patients with systemic inflammatory response syndrome without cancer, neurologic disease, or liver disease. Acetaminophen was administered for 88 of 166 fevers. Febrile episodes in which other antipyretic drugs or external cooling were administered were excluded. The response to acetaminophen was variable, but the absolute temperature reduction was slightly higher (mean, 0.86 versus 0.56 degrees C; P = .0362), and the cooling rate was slightly more rapid (mean, 0.20 versus 0.13 degrees C per hour; P = .0152) in acetaminophen-treated versus untreated fevers. There were no obvious differences between the most and least responsive patients.

Conclusions: We conclude that acetaminophen has significant albeit modest antipyretic activity in critically ill patients.

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Conflict of interest statement

The authors have no conflicts of interest to declare. The study sponsors had no role in collection or analysis of the data presented.

Figures

Figure 1
Figure 1. Comparison of Temperature Drop in Untreated Fevers and Fevers Treated with Acetaminophen
The maximum drop in temperature within 5 hours of acetaminophen administration (B) or equivalent time period in untreated fevers (A) is compared. The distributions, means, and the 95% confidence interval (95% CI) for the difference between the 88 treated and 78 untreated febrile episodes and p-value are shown.
Figure 2
Figure 2. Comparison of Temperature Normalization in Untreated Fevers and Fevers Treated with Acetaminophen
The percent resolution of fever, defined as return to 37°C within 5 hours of acetaminophen administration (B) or equivalent time period in untreated fevers (A) is compared. The distributions, means, and the 95% confidence interval (95% CI) for the difference between the 88 treated and 78 untreated febrile episodes and p-value are shown.
Figure 3
Figure 3. Comparison of Cooling Rate in Untreated Fevers and Fevers Treated with Acetaminophen
The cooling rate during the 5 hours after acetaminophen administration (B) or equivalent time period in untreated fevers (A) is compared. The cooling rate is defined as the slope of the linear regression of temperature vs. time for each febrile episode. The distributions, means, and the 95% confidence interval (95% CI) for the difference between the 88 treated and 78 untreated febrile episodes and p-value are shown.
See this image and copyright information in PMC

References

    1. Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel R. The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. J Amer Med Assoc. 1995;273:117–123. - PubMed
    1. Hasday JD, Fairchild KD, Shanholtz C. The role of fever in the infected host. Microbes and Infection. 2000;2:1–14. - PubMed
    1. Hajat C, Hajat S, Sharma P. Effects of poststroke pyrexia on stroke outcome : a meta-analysis of studies in patients. Stroke. 2000;31:410–414. - PubMed
    1. Jiang JY, Gao GY, WP L, Yu MK, Zhu C. Early indicators of prognosis in 846 cases of severe traumatic brain injury. J Neurotrauma. 2002;19:869–874. - PubMed
    1. Bernard GR, Wheeler AP, Russell JA, Schein R, Summer WR, Steinberg KP, Fulkerson WJ, Wright PE, Christman BW, Dupont WD, et al. The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group [see comments] N Engl J Med. 1997;336(13):912–918. - PubMed

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