Effects of IV Acetaminophen on Core Body Temperature and Hemodynamic Responses in Febrile Critically Ill Adults: A Randomized Controlled Trial.
OBJECTIVE
To determine the effects of IV acetaminophen on core body temperature, blood pressure, and heart rate in febrile critically ill patients.


METHODS
Randomized, double-blind, placebo-controlled clinical trial.


METHODS
Three adult ICUs at a large, urban, academic medical center.


METHODS
Forty critically ill adults with fever (core temperature, ≥ 38.3°C).


METHODS
An infusion of acetaminophen 1 g or saline placebo over 15 minutes.


RESULTS
Core temperature and vital signs were measured at baseline and at 5-15-minute intervals for 4 hours after infusion of study drug. The primary outcome was time-weighted average core temperature adjusted for baseline temperature. Secondary outcomes included adjusted time-weighted average heart rate, blood pressure, and respiratory rate, along with changes-over-time for each. Baseline patient characteristics were similar in those given acetaminophen and placebo. Patients given acetaminophen had an adjusted time-weighted average temperature that was 0.47°C less than those given placebo (95% CI, -0.76 to -0.18; p = 0.002). The acetaminophen group had significantly lower adjusted time-weighted average systolic blood pressure (-17 mm Hg; 95% CI, -25 to -8; p < 0.001), mean arterial pressure (-7 mm Hg; 95% CI, -12 to -1; p = 0.02), and heart rate (-6 beats/min; 95% CI, -10 to -1; p = 0.03). Changes-over-time temperature, blood pressure, and heart rate outcomes were also significantly lower at 2 hours, but not at 4 hours.


CONCLUSIONS
Among febrile critically ill adults, treatment with acetaminophen decreased temperature, blood pressure, and heart rate. IV acetaminophen thus produces modest fever reduction in critical care patients, along with clinically important reductions in blood pressure.
1University of California, San Francisco (UCSF) School of Nursing, San Francisco, CA.2UCSF School of Medicine, San Francisco, CA.3Department of Outcomes Research, Cleveland Clinic, Anesthesiology Institute, Cleveland, OH.4UCSF School of Nursing, San Francisco, CA.
Hildy M
HM
Schell-Chaple
Kathleen D
KD
Liu
Michael A
MA
Matthay
Daniel I
DI
Sessler
Kathleen A
KA
Puntillo
D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D001831:Body Temperature / Q000187:drug effects; D016638:Critical Illness / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D005334:Fever / Q000188:drug therapy*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D056152:Respiratory Rate / Q000187:drug effects
D000082:Acetaminophen