Haemodynamic changes with paracetamol in critically-ill children

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Abstract

Purpose

Paracetamol has been associated with a reduction in blood pressure, especially in febrile, critically-ill adults. We hypothesised that blood pressure would fall following administration of paracetamol in critically-ill children and this effect would be greater during fever and among children with a high body surface area to weight ratio.

Methods

A 12-month prospective observational study of children (0–16 years) admitted to paediatric intensive care, who underwent pulse contour analysis and received paracetamol concurrently.

Results

Mean arterial blood pressure decreased significantly by 4.7% from baseline (95% CI 1.75–8.07%) in 31 children following 148 doses of paracetamol. The nadir was 2-hour post-dose. The effect was pronounced in children with fever at baseline (6.4%, 95% CI 2.8–10%), although this was not statistically significant. There was no simple relationship between this effect and body surface area to weight ratio. The association between a change in blood pressure and changes in heart rate or measured stroke volume was poor; therefore it was likely that a change in the systemic vascular resistance contributes most to this effect.

Conclusion

There is a significant but modest reduction in blood pressure post-paracetamol in critically-ill children. This is likely related to a change in systemic vascular resistance.

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