Acetaminophen for fever in critically iII patients with suspected infection

Paul Young*, Manoj Saxena, Rinaldo Bellomo, Ross Freebairn, Naomi Hammond, Frank van Haren, Mark Holliday, Seton Henderson, Diane Mackle, Colin McArthur, Shay McGuinness, John Myburgh, Mark Weatherall, Steve Webb, Richard Beasley, HEAT Investigators, Australia and New Zealand Intensive Care Society Clinical Trials Group

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

103 Citations (Scopus)

Abstract

Background: Acetaminophen is a common therapy for fever in patients in the intensive care unit (ICU) who have probable infection, but its effects are unknown. Methods: We randomly assigned 700 patients with fever (body temperature, ≥38°C) and known or suspected infection to receive either 1 g of intravenous acetaminophen or placebo every 6 hours until ICU discharge, resolution of fever, cessation of antimicrobial therapy, or death. The primary outcome was ICU-free days (days alive and free from the need for intensive care) from randomization to day 28. Results: The number of ICU-free days to day 28 did not differ significantly between the acetaminophen group and the placebo group: 23 days (interquartile range, 13 to 25) among patients assigned to acetaminophen and 22 days (interquartile range, 12 to 25) among patients assigned to placebo (Hodges-Lehmann estimate of absolute difference, 0 days; 96.2% confidence interval [CI], 0 to 1; P = 0.07). A total of 55 of 345 patients in the acetaminophen group (15.9%) and 57 of 344 patients in the placebo group (16.6%) had died by day 90 (relative risk, 0.96; 95% CI, 0.66 to 1.39; P = 0.84). Conclusions: Early administration of acetaminophen to treat fever due to probable infection did not affect the number of ICU-free days. (Funded by the Health Research Council of New Zealand and others; HEAT Australian New Zealand Clinical Trials Registry number, ACTRN12612000513819.).

Original languageEnglish
Pages (from-to)2215-2224
Number of pages10
JournalNew England Journal of Medicine
Volume373
Issue number23
DOIs
Publication statusPublished - 3 Dec 2015
Externally publishedYes

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