title: Paracetamol in fever in critically ill patients-an update.
abstract: Fever, which is arbitrary defined as an increase in body temperature above 38.3°C, can affect up to 90% of patients admitted in intensive care unit. Induction of fever is mediated by the release of pyrogenic cytokines (tumor necrosis factor α, interleukin 1, interleukin 6, and interferons). Fever is associated with increased length of stay in intensive care unit and with a worse outcome in some subgroups of patients (mainly neurocritically ill patients). Although fever can increase oxygen consumption in unstable patients, on the contrary, it can activate physiologic systems that are involved in pathogens clearance. Treatments to reduce fever include the use of antipyretics. Thus, the reduction of fever might reduce the ability to develop an efficient host response. This balance, between harms and benefits, has to be taken into account every time we decide to treat or not to treat fever in a given patient. Among the antipyretics, paracetamol is one of the most common used. Paracetamol is a synthetic, nonopioid, centrally acting analgesic, and antipyretic drug. Its antipyretic effect occurs because it inhibits cyclooxygenase-3 and the prostaglandin synthesis, within the central nervous system, resetting the hypothalamic heat-regulation center. In this clinical review, we will summarize the use of paracetamol as antipyretic in critically ill patients (sepsis, trauma, neurological, and medical).
authors.affiliation: Dipartimento di Emergenza-Urgenza, ASST Santi Paolo e Carlo, Milan, Italy; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy. Electronic address: chiumello@libero.it.
authors.forename: D
authors.initials: D
authors.lastname: Chiumello
authors.affiliation: Dipartimento di Emergenza-Urgenza, ASST Santi Paolo e Carlo, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Gotti
authors.affiliation: Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Vergani
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D000700:Analgesics; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D058633:Antipyretics / Q000627:therapeutic use*; D016638:Critical Illness; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D005334:Fever / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007362:Intensive Care Units; D007372:Interferons / Q000378:metabolism; D007375:Interleukin-1 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D009422:Nervous System Diseases; D011451:Prostaglandin-Endoperoxide Synthases; D018805:Sepsis; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014947:Wounds and Injuries
chemical_list: D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D058633:Antipyretics; D016861:Cyclooxygenase Inhibitors; C508600:IL6 protein, human; D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D000082:Acetaminophen; D007372:Interferons; D011451:Prostaglandin-Endoperoxide Synthases; C466421:cyclooxygenase-3
keywords: Critical illness; Fever; Paracetamol