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Published on: May 2, 2017
Paracetamol in critical illness: a review
Sarah Jefferies1, Manoj Saxena, Paul Young
1Medical Research Institute of New Zealand, Wellington, New Zealand. Sarah.Jefferies@mrinz.ac.nz
Summary
Despite its common use, evidence for paracetamol (acetaminophen) in critical care is limited. Further research is needed to establish its safety and efficacy in intensive care unit (ICU) patients.
Area of Science:
- Pharmacology and critical care medicine.
- Evidence-based medicine and clinical trial research.
Background:
- Paracetamol (acetaminophen) is a globally prevalent medication.
- This review was prompted by protocol development for two randomized controlled trials on paracetamol use in ICU patients: the HEAT and PARITY studies.
Purpose of the Study:
- To provide historical context for paracetamol's clinical introduction.
- To present paracetamol's pharmacology in critical illness.
- To evaluate current evidence for its use as an antipyretic and analgesic in intensive care.
Main Methods:
- Comprehensive literature searches were conducted using keywords such as "paracetamol," "acetaminophen," "critical illness," and "intensive care."
- Databases searched included Embase, MEDLINE, and PubMed from 1947/1950 to July 2011.
- Relevant articles were reviewed, with reference list searching and hand-searching to identify the highest quality evidence.
Main Results:
- Limited data exist on paracetamol's pharmacology in critically ill patients.
- In sepsis, paracetamol may potentially inhibit immune responses.
- While paracetamol reduces fever in neurological injury, it does not improve outcomes; it also fails to reduce pain or opioid side effects when used with opioids post-surgery.
Conclusions:
- There is a significant lack of data supporting the utility of paracetamol in critically ill patients, despite its widespread use.
- Further research is essential to define appropriate use of paracetamol in the intensive care setting.
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