Paracetamol induced skin blood flow and blood pressure changes in febrile intensive care patients: An observational study

Boyle, M.; Nicholson, Lisa; O’Brien, Maureen M.; Collins, David W.; Bihari, D.; Flynn, Gordon; Walsh, William J.

doi:10.1016/j.aucc.2010.12.014

Cited by 8 publications

(20 citation statements)

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“…Using pulse contour cardiac output analysis, the authors showed that the drop in MAP was due to a reduction in cardiac index and peripheral vasodilation and the consequent decrease in peripheral vascular resistance. Similar changes in skin blood flow and vascular resistance were reported by Boyle et al [6].…”

Section: Discussionsupporting

confidence: 88%

“…According to the company's product information leaflet [2], the rate of hypotension complicating intravenous paracetamol treatment ranges from 0.01 to 0.1%. However, recent studies in critically ill adults reported a much higher incidence [3][4][5][6][7][8][9]. Cantais et al [3] observed a 15% reduction in mean arterial pressure (MAP) in 52% of critically ill adults receiving intravenous paracetamol; in 35% of them, intervention in the form of a fluid bolus or an increase in vasopressor dose was required.…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support

et al. 2020

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Background: Treatment with intravenous paracetamol may impair hemodynamics in critically ill adults. Few data are available in children. The aim of this study was to investigate the frequency, extent, and risk factors of hypotension following intravenous paracetamol administration in children with septic shock on inotropic support. Methods: We retrospectively reviewed the electronic medical charts of all children aged 1 month to 18 years with septic shock who were treated with intravenous paracetamol while on inotropic support at the critical care unit of a tertiary pediatric medical center in 2013-2018. Data were collected on patient demographics, underlying disease, Pediatric Logistic Organ Dysfunction (PELOD) score, hemodynamic parameters before and up to 120 min after paracetamol administration, and need for inotropic support or intravenous fluid bolus. The main outcome measures were a change in blood pressure, hypotension, and hypotension requiring intervention. Results: The cohort included 45 children of mean age 8.9 ± 5.1 years. The mean inotropic support score was 12.1 ± 9.5. A total of 105 doses of paracetamol were administered. The lowest mean systolic pressure (108 ± 15 mmHg) was recorded at 60 min (p = 0.002). Systolic blood pressure decreased at 30, 60, 90, and 120 min after delivery of 50, 67, 61, and 59 drug doses, respectively. There were 5 events of systolic hypotension (decrease of 1 to 16 mmHg below systolic blood pressure hypotensive value). Mean arterial pressure decreased by ≥ 15% in 8 drug doses at 30 min (7.6%, mean − 19 ± 4 mmHg), 18 doses at 60 min (17.1%, mean − 20 ± 7 mmHg), 16 doses at 90 min (15.2%, mean − 20 ± 5 mmHg), and 17 doses at 120 min (16.2%, mean − 19 ± 5 mmHg). Mean arterial hypotension occurred at the respective time points in 2, 13, 10, and 9 drug doses. After 12 drug doses (11.4%), patients required an inotropic dose increment or fluid bolus. Conclusions: Hypotensive events are not uncommon in critically ill children on inotropic support treated with intravenous paracetamol, and physicians should be alert to their occurrence and the need for intervention.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support

et al. 2020

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“…However, with growing use, concerns have developed in critical care literature, which suggest that i.v. formulations may be associated with transient hypotension . Additionally, studies examining the haemodynamic effects of i.v.…”

Section: Introductionmentioning

confidence: 99%

The haemodynamic effects of intravenous paracetamol (acetaminophen) in healthy volunteers: a double‐blind, randomized, triple crossover trial

Chiam

Weinberg

Bailey

et al. 2016

Brit J Clinical Pharma

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Aim The haemodynamic effects of intravenous paracetamol have not been systematically investigated. We compared the physiological effects of intravenous mannitol‐containing paracetamol, and an equivalent dosage of mannitol, and normal saline 0.9% in healthy volunteers. Methods We performed a blinded, triple crossover, randomized trial of 24 adult healthy volunteers. Participants received i.v. paracetamol (1 g paracetamol +3.91 g mannitol 100 ml–1), i.v. mannitol (3.91 g mannitol 100 ml–1) and i.v. normal saline (100 ml). Composite primary end points were changes in mean arterial pressure (MAP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) measured pre‐infusion, during a 15 min infusion period and over a 45 min observation period. Systemic vascular resistance index (SVRI) and cardiac index were measured at the same time points. Results Infusion of paracetamol induced a transient yet significant decrease in blood pressures from pre‐infusion values (MAP –1.85 mmHg, 95% CI –2.6, –1.1, SBP –0.54 mmHg, 95% CI –1.7, 0.6 and DBP −1.92 mmHg, 95% CI –2.6, –1.2, P < 0.0001), associated with a transient reduction in SVRI and an increase in cardiac index. Changes were observed, but to a lesser extent with normal saline (MAP –0.15 mmHg, SBP +1.44 mmHg, DBP −–0.73 mmHg, P < 0.0001), but not with mannitol (MAP +1.47 mmHg, SBP +4.03 mmHg, DBP +0.48 mmHg, P < 0.0001). Conclusions I.v. paracetamol caused a transient decrease in blood pressure immediately after infusion. These effects were not seen with mannitol or normal saline. The physiological mechanism was consistent with vasodilatation. This study provides plausible physiological data in a healthy volunteer setting, supporting transient changes in haemodynamic variables with i.v. paracetamol and justifies controlled studies in the peri‐operative and critical care setting.

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“…One of the first studies specifically examining the hemodynamic effects of the new ready-to-use formulation of IV paracetamol was published in 2010 5 . This study showed a significant decrease in systolic blood pressure (SBP) with the use of IV paracetamol.Boyleet al 6 ., however, provided evidence that IV paracetamol can cause reduced blood pressure up to 60 minutes after infusion. Recently, Needleman 7 investigated the safety of rapid infusion of IV paracetamol.…”

Section: Discussionmentioning

confidence: 99%

“…Intravenous paracetamol-induced hypotension maybe clinically important, especially in the setting of critical illness where it is most frequently reported [5][6][7][10][11][12][13][14] . Boyle et al 6 . suggested there might be a relationship between reduced skin blood flow and hypotension following administration of paracetamol in febrile patients.…”

Section: Discussionmentioning

confidence: 99%

Paracetamol infusion-related severe hypotension and cardiac arrest in a child

et al. 2016

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Paracetamol (also known as Acetaminophen) is an antipyretic, non-opioid analgesic, and non-steroidal anti-inflammatory drug (NSAID), and is one of the most commonly used medications worldwide. In recent years, IV paracetamol has been frequently used in hospitalized patients to reduce fever and pain. Significant adverse reactions associated with intravenous paracetamol are extremely rare. Typically reported adverse events include hypotension, malaise, hypersensitivity reaction, liver enzyme elevation, and thrombocytopenia. We present herein a case of IV paracetamol infusion-related severe hypotension and cardiac arrest.

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Paracetamol induced skin blood flow and blood pressure changes in febrile intensive care patients: An observational study

Cited by 8 publications

References 0 publications

Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support

Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support

The haemodynamic effects of intravenous paracetamol (acetaminophen) in healthy volunteers: a double‐blind, randomized, triple crossover trial

Paracetamol infusion-related severe hypotension and cardiac arrest in a child

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