Paracetamol therapy for septic critically ill patients: a retrospective observational study

There is little information on the use of paracetamol for septic critically ill patients. We hypothesised that paracetamol use is common in such patients, but its administration is not predictably related to body temperature.

To study the epidemiology and associations of paracetamol use in a cohort of septic critically ill patients.

Retrospective observational study.

Cohort of 106 patients admitted with a sepsis-related diagnostic code to the intensive care unit of a tertiary hospital, 14 December 2009 - 8 August 2010.

Using the ICU database, we identified all patients admitted with sepsis during the study period. We audited their electronic medical records to identify paracetamol administration and body temperature. The paracetamol administered and tympanic temperature at 00:00, 06:00, 12:00 and 18:00 hours for the first 7 days of admission were recorded. The reason for paracetamol administration was not documented.

73/106 (69%) patients received paracetamol at least once; 10% of all patients and 23% of postoperative patients had paracetamol for every temperature measurement. The median length of stay was 3 days and the mean total ICU paracetamol dose per patient was 6.4 g. Overall, 44% of patients received paracetamol for their peak temperature (56% in the fever group v 37% in the non-fever group; P = 0.07). Only 36/106 patients had a fever and 88% in the fever group had paracetamol at least once in the first 7 days, compared with 60% in the non-fever group (P=0.004). After adjustment for key variables, patients with fever were more likely to receive paracetamol (odds ratio, 6.8 [95% CI, 1.9- 24.7]; P=0.004). Patients with fever were more likely to die in ICU than patients without fever (P<0.001), although those who died in ICU did not receive more paracetamol.

Paracetamol administration is common among septic critically ill patients with or without fever, and more likely to occur when fever is present. However, paracetamol is not predictably given for the highest temperature in febrile patients. Future investigations are needed to understand under what circumstances and why paracetamol is given or not given to febrile or afebrile septic ICU patients.