Acetaminophen for fever in critically iII patients with suspected infection

Paul Jeffrey Young, Manoj K Saxena, Rinaldo Bellomo, Ross C Freebairn, Naomi E Hammond, Frank M P Van Haren, Mark Holliday, Seton J Henderson, Diane Mackle, Colin McArthur, Shay P McGuinness, John A Myburgh, Mark W Weatherall, Steven A R Webb, Richard W Beasley

Research output: Contribution to journalArticleResearchpeer-review

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 - 2015

Cite this

Young, P. J., Saxena, M. K., Bellomo, R., Freebairn, R. C., Hammond, N. E., Van Haren, F. M. P., ... Beasley, R. W. (2015). Acetaminophen for fever in critically iII patients with suspected infection. New England Journal of Medicine, 373(23), 2215 - 2224. https://doi.org/10.1056/NEJMoa1508375
Young, Paul Jeffrey ; Saxena, Manoj K ; Bellomo, Rinaldo ; Freebairn, Ross C ; Hammond, Naomi E ; Van Haren, Frank M P ; Holliday, Mark ; Henderson, Seton J ; Mackle, Diane ; McArthur, Colin ; McGuinness, Shay P ; Myburgh, John A ; Weatherall, Mark W ; Webb, Steven A R ; Beasley, Richard W. / Acetaminophen for fever in critically iII patients with suspected infection. In: New England Journal of Medicine. 2015 ; Vol. 373, No. 23. pp. 2215 - 2224.
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title = "Acetaminophen for fever in critically iII patients with suspected infection",
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.).",
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doi = "10.1056/NEJMoa1508375",
language = "English",
volume = "373",
pages = "2215 -- 2224",
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Young, PJ, Saxena, MK, Bellomo, R, Freebairn, RC, Hammond, NE, Van Haren, FMP, Holliday, M, Henderson, SJ, Mackle, D, McArthur, C, McGuinness, SP, Myburgh, JA, Weatherall, MW, Webb, SAR & Beasley, RW 2015, 'Acetaminophen for fever in critically iII patients with suspected infection' New England Journal of Medicine, vol. 373, no. 23, pp. 2215 - 2224. https://doi.org/10.1056/NEJMoa1508375

Acetaminophen for fever in critically iII patients with suspected infection. / Young, Paul Jeffrey; Saxena, Manoj K; Bellomo, Rinaldo; Freebairn, Ross C; Hammond, Naomi E; Van Haren, Frank M P; Holliday, Mark; Henderson, Seton J; Mackle, Diane; McArthur, Colin; McGuinness, Shay P; Myburgh, John A; Weatherall, Mark W; Webb, Steven A R; Beasley, Richard W.

In: New England Journal of Medicine, Vol. 373, No. 23, 2015, p. 2215 - 2224.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Acetaminophen for fever in critically iII patients with suspected infection

AU - Young, Paul Jeffrey

AU - Saxena, Manoj K

AU - Bellomo, Rinaldo

AU - Freebairn, Ross C

AU - Hammond, Naomi E

AU - Van Haren, Frank M P

AU - Holliday, Mark

AU - Henderson, Seton J

AU - Mackle, Diane

AU - McArthur, Colin

AU - McGuinness, Shay P

AU - Myburgh, John A

AU - Weatherall, Mark W

AU - Webb, Steven A R

AU - Beasley, Richard W

PY - 2015

Y1 - 2015

N2 - 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.).

AB - 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.).

UR - http://www.nejm.org/doi/pdf/10.1056/NEJMoa1508375

U2 - 10.1056/NEJMoa1508375

DO - 10.1056/NEJMoa1508375

M3 - Article

VL - 373

SP - 2215

EP - 2224

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

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