title: Haemodynamic changes with paracetamol in critically-ill children.
abstract: Paracetamol has been associated with a reduction in blood pressure, especially in febrile, critically-ill adults. We hypothesised that blood pressure would fall following administration of paracetamol in critically-ill children and this effect would be greater during fever and among children with a high body surface area to weight ratio.
  
  
  
  A 12-month prospective observational study of children (0-16years) admitted to paediatric intensive care, who underwent pulse contour analysis and received paracetamol concurrently.
  
  
  
  Mean arterial blood pressure decreased significantly by 4.7% from baseline (95% CI 1.75-8.07%) in 31 children following 148 doses of paracetamol. The nadir was 2-hour post-dose. The effect was pronounced in children with fever at baseline (6.4%, 95% CI 2.8-10%), although this was not statistically significant. There was no simple relationship between this effect and body surface area to weight ratio. The association between a change in blood pressure and changes in heart rate or measured stroke volume was poor; therefore it was likely that a change in the systemic vascular resistance contributes most to this effect.
  
  
  
  There is a significant but modest reduction in blood pressure post-paracetamol in critically-ill children. This is likely related to a change in systemic vascular resistance.
authors.affiliation: Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, WC1N 3JH, UK; Respiratory, Anaesthesia and Critical Care Section, UCL Institute of Child Health, London, WC1N 1EH, UK. Electronic address: samiran.ray@gosh.nhs.uk.
authors.forename: Samiran
authors.initials: S
authors.lastname: Ray
authors.affiliation: Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, WC1N 3JH, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brick
authors.affiliation: Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, WC1N 3JH, UK; Respiratory, Anaesthesia and Critical Care Section, UCL Institute of Child Health, London, WC1N 1EH, UK.
authors.forename: Sainath
authors.initials: S
authors.lastname: Raman
authors.affiliation: MRC Biostatistics Unit, Institute of Public Health, Cambridge, CB2 0SR, UK.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Birrell
authors.affiliation: Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, WC1N 1EH, UK.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Klein
authors.affiliation: Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, WC1N 3JH, UK; Respiratory, Anaesthesia and Critical Care Section, UCL Institute of Child Health, London, WC1N 1EH, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Peters
mesh_terms: D000082:Acetaminophen / Q000494:pharmacology* / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000494:pharmacology* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D005334:Fever / Q000188:drug therapy; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
keywords: Child; Critical care; Fever; Paracetamol; Physiologic monitoring