Here’s a link to an interesting paper from Oz on paracetamol usage in crit care! Food for thought…….á la statins…

What was it looking for

Did paracetamol influence outcome of ICU patients? Primary outcome, in-hospital mortality and secondary outcome, ICU mortality.

Type

Multicenter, retrospective observational study, 17,110 patients. Stats thorough with multi-variate analysis and good confounder eradication. But…No control possible over interventions clinicians made amongst the 4 ICU’s so indication bias (?? other cooling measures / other drugs etc).

Scope

As many as 64% of ICU patients receive para, therefore it is one of the most commonly prescribed drugs

Previous studies

Antipyretic therapy was neither beneficial nor harmful in critically ill adults without neurological injury. No previous association between M+M found like this before.

Future

Need a RCT multicentre / multinational trial now.

Will it change practice?

For me; I will aim to ensure all patients receive this as 1st line analgesic and routine anti-pyretic unless there is good reason not to. This rings bells with papers regarding statin therapy and improved ICU outcome.

Messages

  1. Little was known about the association between paracetamol administration and patient outcomes

  2. Paracetamol administration is common in ICU and appears independently associated with reduced in-hospital mortality and time to death after adjustment for multiple potential confounders and propensity score

  3. The association between paracetamol and decreased mortality and/or time to death was broadly consistent across surgical and medical patients.
  4. This association applied to surgical and medical patients and to febrile and non-febrile patients
  5. This association, however, was modified by the presence of fever, suspected infection and lesser illness severity and may represent the effect of indication bias.