Antipyretic Efficacy of Ibuprofen vs Acetaminophen

Kauffman, Ralph E.; Sawyer, L.; Scheinbaum, Monte L.

doi:10.1001/archpedi.1992.02160170102024

Cited by 54 publications

(63 citation statements)

References 11 publications

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“…Drug-induced antipyrexia is preferred because it is easier than application of iced sponges and has proved to be efficient in paediatric studies. [13][14][15] Our study has demonstrated that external cooling, under sedation-analgesia conditions, is a valuable means of decreasing temperature with a concomitant decrease in oxygen consumption. The 12% decrease in oxygen consumption in externally cooled patients matched previously published data reporting a 5-7% change in metabolism per 1 ЊC change in temperature.…”

Section: Discussionmentioning

confidence: 83%

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

Poblete¹,

Romand²,

Pichard³

et al. 1997

British Journal of Anaesthesia

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SummaryWe have measured the metabolic response to sequential administration of propacetamol, metamizol and/or external cooling in 20 febrile patients under sedation and analgesia and during mechanical ventilation. There was no change in temperature (TЊ) after propacetamol therapy, whereas after metamizol only a small decrease was noted (from 38.9 (SEM 0.2) to 38.5 (0.3) ЊC; P:0.02). External cooling produced a significant decrease in TЊ (39.1 (0.2) to 37.1 (0.2) ЊC; P:0.0001) accompanied by a decrease in energy expenditure (EE) (2034 (73) to 1791 (88) kcal day 91 ; P:0.004). Heart rate and minute ventilation decreased significantly in parallel. There were no other changes in haemodynamics or pulmonary gas exchanges. We conclude that propacetamol and metamizol did not produce a clinically significant decrease in TЊ in febrile ICU patients whereas external cooling decreased both TЊ and EE. The parallel decrease in body temperature and EE seemed to be related to opioid administration or sedation, or both. (Br. J. Anaesth. 1997; 78: 23-127 Fever in critically ill patients is related frequently to either the systemic inflammatory response syndrome (SIRS) or infection. Usually fever is treated with antipyretic drugs, often paracetamol or metamizol. External cooling by different methods, such as sponging the body surface with ice-cooled water, is also used. 1 Even if reducing fever is still controversial from an immunological point of view, there is little doubt that patient comfort and metabolic demand can be improved by this procedure. 2 Indeed, a previous study in critically ill patients demonstrated diminished oxygen consumption related to decreased body temperature improving the oxygen demand-delivery ratio. 3 However, body cooling in healthy humans results in shivering which increases energy expenditure (EE).The aim of this study was to measure EE as an integrated indicator of body metabolic activity after reduction in temperature. Our hypothesis was that external cooling may induce an increase in EE, in contrast with drugs which, by resetting the thermoregulatory set point, decrease EE. Therefore, we designed a prospective, unblinded, crossover study to evaluate the respective effects of centrally acting drugs (propacetamol or metamizol) or external physical cooling in febrile ICU patients. Patients and methodsThe study was approved by the Ethics Committee of our institution. The requirement for informed consent was waived by the committee who judged that the therapies were applied independently by the attending physician and were accepted in clinical practice, and no invasive measurements were made. We studied 20 patients undergoing mechanical ventilation via a tracheal tube, with a rectal temperature greater than 38.5 ЊC and in whom the physician in charge wished to decrease fever. No patient had an inspired oxygen fraction greater than 0.6, a pneumothorax or a broncho-pleural fistula. Patients' lungs were ventilated with a Veolar-Hamilton (Hamilton Bonaduz, Switzerland) or Engström-Erica ventilator (Engström,...

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Section: Discussionmentioning

confidence: 83%

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

Poblete¹,

Romand²,

Pichard³

et al. 1997

British Journal of Anaesthesia

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“…I0 l 1 Its antipyretic properties have also been established. [12][13][14][15] However, these antipyretic studies tested a single dose and excluded children under 2 years old. Multiple dose studies have also excluded children less than 2 years old, '5 16 and many studies exclude children of all ages with wheezing or asthma.…”

Section: Discussionmentioning

confidence: 99%

Comparing efficacy and tolerability of ibuprofen and paracetamol in fever.

McIntyre

Hull

1996

Archives of Disease in Childhood

100

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The purpose of this study was to compare antipyretic activity and evaluate tolerability of ibuprofen and paracetamol suspension in the treatment of febrile children. It was designed as a double blind, parallel group, multiple dose study comparing ibuprofen (20 mg/kg/24 hours) with paracetamol (50 mg/kg/24 hours) given at six hourly intervals for a maximum of 12 doses. Children on paediatric wards between the ages of 0-2 and 12 years, with fever as defined by an axillary temperature ¢ 37 5°C, were included. The main outcome measures were: change in axillary temperature; palatability of medication; changes in irritability and clinical condition; overall efficacy at the end of treatment; and number and nature of adverse events.The mean temperature change from baseline at four hours was -1-8°C and -1 60C in ibuprofen and paracetamol groups respectively. In both groups: median palatability score was 'no reaction'; median irritability score at end point was 'not irritable'; median score for change in clinical condition was 'improved'; and median score for overall efficacy was 'good effect'. The proportion of patients experiencing adverse events was similar in both groups, the majority of events having doubtful or no relationship to therapy and being mild in severity.In conclusion, ibuprofen suspension was as effective and well tolerated as paracetamol in treatment of fever in young children.

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“…Indeed, the entire concept of treating fever in ICU patients without cerebral injury has been questioned. 13,14 NSAID administration produces greater temperature decrements and longer duration of antipyresis than acetaminophen in studies in febrile children, 15 and was also associated with faster resolution of fever in patients with malaria. 16 In a nonrandomized open label trial in febrile cancer patients iv propacetamol (acetaminophen) had lower antipyretic efficacy than an NSAID (iv diclofenac).…”

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confidence: 99%

“…18,19 Acetaminophen may modestly promote hypothermia < 36.5°C or prevent hyperthermia > 37.5°C. 15 Unfortunately, the clinical significance of this effect appears small. Pharmacologic antipyresis with acetaminophen and/or NSAID in post-cardiac arrest patients requires more study, however, ongoing use of these medications was recommended until additional data are available (Grade E).…”

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confidence: 99%

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Management following resuscitation from cardiac arrest: Recommendations from the 2003 Rocky mountain critical care conference

Bell

Brindley

Forrest

et al. 2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To propose a strategy for the management of patients admitted to critical care units after resuscitation from cardiac arrest.S So ou ur rc ce e: : Prior to the conference relevant studies were identified via literature searches and brief reviews circulated on the following topics: glucose and blood pressure management; therapeutic hypothermia; prearrest outcome prediction; post-arrest outcome prediction; and management of myocardial ischemia. Two days were devoted to assessing evidence and developing a management strategy at the conference. Consensus opinion of conference participants [intensive care unit (ICU) physicians] was used when high grade evidence was unavailable. Additional literature searches and data grading were performed post-conference. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : High grade evidence was lacking in most areas. Specific goals of treatment were proposed for: general care; neurologic care; respiratory care; cardiac care; and gastrointestinal care. There was adequate evidence to recommend therapeutic hypothermia for comatose patients who had witnessed ventricular fibrillation or ventricular tachycardia arrests. Conference participants supported extending therapeutic hypothermia to other presenting rhythms in selected circumstances. Additional goals included mean arterial pressure 80 to 100 mmHg, glucose 5 to 8 mmol·L -1 using insulin infusions, and PaO 2 > 100 mmHg for the first 24 hr. Absent withdrawal to pain 72 hr after resuscitation should prompt consideration of palliative care. The level of evidence for other recommendations was low.C Co on nc cl lu us si io on ns s: : The proposed management strategy represents an approach to manage patients in the ICU following resuscitation from cardiac arrest. Most of the recommendations are based on low grade evidence. Additional research is needed to improve the evidence base. A standard post-arrest management strategy could help facilitate future research. Objectif : Proposer une stratégie de traitement à adopter avec les patients admis aux unités de soins intensifs (USI) après la réanimation post-arrêt cardiaque. Source : Avant la conférence, les études utiles ont été repérées dans les publications et de brèves revues ont circulé sur

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Antipyretic Efficacy of Ibuprofen vs Acetaminophen

Cited by 54 publications

References 11 publications

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

Comparing efficacy and tolerability of ibuprofen and paracetamol in fever.

Management following resuscitation from cardiac arrest: Recommendations from the 2003 Rocky mountain critical care conference

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