Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support
Abstract Background Treatment with intravenous paracetamol may impair hemodynamics in critically ill adults. Few data are available in children. The aim of this study was to investigate the frequency, extent, and risk factors of hypotension following intravenous paracetamol administration in childre...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-01-01
|
| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40560-020-0430-0 |
| _version_ | 1818557195841699840 |
|---|---|
| author | Elhanan Nahum Avichai Weissbach Eytan Kaplan Gili Kadmon |
| author_facet | Elhanan Nahum Avichai Weissbach Eytan Kaplan Gili Kadmon |
| author_sort | Elhanan Nahum |
| collection | DOAJ |
| description | Abstract Background Treatment with intravenous paracetamol may impair hemodynamics in critically ill adults. Few data are available in children. The aim of this study was to investigate the frequency, extent, and risk factors of hypotension following intravenous paracetamol administration in children with septic shock on inotropic support. Methods We retrospectively reviewed the electronic medical charts of all children aged 1 month to 18 years with septic shock who were treated with intravenous paracetamol while on inotropic support at the critical care unit of a tertiary pediatric medical center in 2013–2018. Data were collected on patient demographics, underlying disease, Pediatric Logistic Organ Dysfunction (PELOD) score, hemodynamic parameters before and up to 120 min after paracetamol administration, and need for inotropic support or intravenous fluid bolus. The main outcome measures were a change in blood pressure, hypotension, and hypotension requiring intervention. Results The cohort included 45 children of mean age 8.9 ± 5.1 years. The mean inotropic support score was 12.1 ± 9.5. A total of 105 doses of paracetamol were administered. The lowest mean systolic pressure (108 ± 15 mmHg) was recorded at 60 min (p = 0.002). Systolic blood pressure decreased at 30, 60, 90, and 120 min after delivery of 50, 67, 61, and 59 drug doses, respectively. There were 5 events of systolic hypotension (decrease of 1 to 16 mmHg below systolic blood pressure hypotensive value). Mean arterial pressure decreased by ≥ 15% in 8 drug doses at 30 min (7.6%, mean − 19 ± 4 mmHg), 18 doses at 60 min (17.1%, mean − 20 ± 7 mmHg), 16 doses at 90 min (15.2%, mean − 20 ± 5 mmHg), and 17 doses at 120 min (16.2%, mean − 19 ± 5 mmHg). Mean arterial hypotension occurred at the respective time points in 2, 13, 10, and 9 drug doses. After 12 drug doses (11.4%), patients required an inotropic dose increment or fluid bolus. Conclusions Hypotensive events are not uncommon in critically ill children on inotropic support treated with intravenous paracetamol, and physicians should be alert to their occurrence and the need for intervention. |
| first_indexed | 2024-12-13T23:56:43Z |
| format | Article |
| id | doaj.art-f115b3fc5b154da79479af1180e3faa8 |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-12-13T23:56:43Z |
| publishDate | 2020-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-f115b3fc5b154da79479af1180e3faa82022-12-21T23:26:31ZengBMCJournal of Intensive Care2052-04922020-01-01811710.1186/s40560-020-0430-0Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic supportElhanan Nahum0Avichai Weissbach1Eytan Kaplan2Gili Kadmon3Pediatric Intensive Care Unit, Schneider Children’s Medical Center of IsraelPediatric Intensive Care Unit, Schneider Children’s Medical Center of IsraelPediatric Intensive Care Unit, Schneider Children’s Medical Center of IsraelPediatric Intensive Care Unit, Schneider Children’s Medical Center of IsraelAbstract Background Treatment with intravenous paracetamol may impair hemodynamics in critically ill adults. Few data are available in children. The aim of this study was to investigate the frequency, extent, and risk factors of hypotension following intravenous paracetamol administration in children with septic shock on inotropic support. Methods We retrospectively reviewed the electronic medical charts of all children aged 1 month to 18 years with septic shock who were treated with intravenous paracetamol while on inotropic support at the critical care unit of a tertiary pediatric medical center in 2013–2018. Data were collected on patient demographics, underlying disease, Pediatric Logistic Organ Dysfunction (PELOD) score, hemodynamic parameters before and up to 120 min after paracetamol administration, and need for inotropic support or intravenous fluid bolus. The main outcome measures were a change in blood pressure, hypotension, and hypotension requiring intervention. Results The cohort included 45 children of mean age 8.9 ± 5.1 years. The mean inotropic support score was 12.1 ± 9.5. A total of 105 doses of paracetamol were administered. The lowest mean systolic pressure (108 ± 15 mmHg) was recorded at 60 min (p = 0.002). Systolic blood pressure decreased at 30, 60, 90, and 120 min after delivery of 50, 67, 61, and 59 drug doses, respectively. There were 5 events of systolic hypotension (decrease of 1 to 16 mmHg below systolic blood pressure hypotensive value). Mean arterial pressure decreased by ≥ 15% in 8 drug doses at 30 min (7.6%, mean − 19 ± 4 mmHg), 18 doses at 60 min (17.1%, mean − 20 ± 7 mmHg), 16 doses at 90 min (15.2%, mean − 20 ± 5 mmHg), and 17 doses at 120 min (16.2%, mean − 19 ± 5 mmHg). Mean arterial hypotension occurred at the respective time points in 2, 13, 10, and 9 drug doses. After 12 drug doses (11.4%), patients required an inotropic dose increment or fluid bolus. Conclusions Hypotensive events are not uncommon in critically ill children on inotropic support treated with intravenous paracetamol, and physicians should be alert to their occurrence and the need for intervention.https://doi.org/10.1186/s40560-020-0430-0ParacetamolHypotensionSeptic shockInotropicChildren |
| spellingShingle | Elhanan Nahum Avichai Weissbach Eytan Kaplan Gili Kadmon Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support Journal of Intensive Care Paracetamol Hypotension Septic shock Inotropic Children |
| title | Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support |
| title_full | Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support |
| title_fullStr | Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support |
| title_full_unstemmed | Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support |
| title_short | Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support |
| title_sort | hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support |
| topic | Paracetamol Hypotension Septic shock Inotropic Children |
| url | https://doi.org/10.1186/s40560-020-0430-0 |
| work_keys_str_mv | AT elhanannahum hemodynamiceffectsofintravenousparacetamolincriticallyillchildrenwithsepticshockoninotropicsupport AT avichaiweissbach hemodynamiceffectsofintravenousparacetamolincriticallyillchildrenwithsepticshockoninotropicsupport AT eytankaplan hemodynamiceffectsofintravenousparacetamolincriticallyillchildrenwithsepticshockoninotropicsupport AT gilikadmon hemodynamiceffectsofintravenousparacetamolincriticallyillchildrenwithsepticshockoninotropicsupport |