Acetaminophen-Induced Changes in Systemic Blood Pressure in Critically Ill Patients: Results of a Multicenter Cohort Study

Abstract

Half of the patients who received IV injections of acetaminophen developed hypotension, and up to one third of the observed episodes necessitated therapeutic intervention. Adequately powered randomized studies are needed to confirm our findings, provide an accurate estimation of the consequences of acetaminophen-induced hypotension, and assess the pathophysiologic mechanisms involved.

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

“…In the study demonstrating the greatest reduction in opioid consumption (84), time to extubation, sedation, and nausea rate were all significantly improved in the acetaminophen group. The risk for IV acetaminophen-associated hypotension (a decrease in the mean arterial pressure > 15 mm Hg may occur in up to 50% of patients) may preclude its use in some patients (85). Given these findings, panel members suggest using acetaminophen (IV, oral, or rectal) to decrease pain intensity and opioid consumption when treating pain in critically ill patients, particularly in patients at higher risk for opioid-associated safety concerns (e.g., critically ill patient recovering from abdominal surgery and at risk for ileus or nausea and vomiting).…”

“…The risks of using nonopioid-adjunctive medications for analgesia in a population at increased risk for adverse drug effects need to be better defined. This includes analysis of liver and renal toxicities secondary to acetaminophen (all routes), hemodynamic instability secondary to IV acetaminophen (85), risk of bleeding secondary to non-COX-1-selective NSAIDs, delirium, and neurotoxicity associated with ketamine (105), and hemodynamic alterations with IV lidocaine (100). The optimal dose and route of administration for these nonopioids in critically ill patients need to be investigated, and studies should be conducted in the critically ill medical patients unable to self-report pain.…”

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

“…In addition, we calculated the differences between the systolic and diastolic blood pressure values and the respective normal means for age expressed as delta (Δ). A negative change of ≥ 15% in MAP after intravenous paracetamol administration was also evaluated, similar to previous studies [3,9]. Temperature was measured either by rectal probe or temperature-sensing indwelling urinary catheters just before and 1 h after paracetamol administration.…”

“…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.…”

Executive Summary: Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

“…When compared with placebo in the perioperative period, use of IV acetaminophen 1 g every 6 hours was associated with reduced pain intensity and opioid consumption 24 hours after surgery (33,34). The risk for IV acetaminophen-associated hypotension may preclude its use in some patients (35). Given these findings, the panel suggests using acetaminophen (IV, oral, or rectal) to decrease pain intensity and opioid consumption when treating pain in critically ill patients, particularly in patients at higher risk for opioid-associated safety concerns.…”