Background

Studies in adults have reported high rates of hypotension following intravenous paracetamol administration.

Objectives

We aimed to investigate the hemodynamic effects of intravenous paracetamol in critically ill children.

Methods

One hundred pediatric intensive care patients who were treated with intravenous paracetamol (Perfalgan^TM) between March and September 2017 were included. A hemodynamic event was defined as a drop of more than 15% in systolic or mean arterial blood pressure within 120 minutes after drug administration. Hypotension was defined as either a drop in systolic blood pressure below the 5^th percentile for age or a hemodynamic event associated with tachycardia, increased lactate level, or treatment with a fluid bolus or vasopressors.

Conclusion

A hemodynamic event was observed in 39 patients (39%). In these patients, systolic blood pressure was in the pre-hypertension or hypertension values in 36/39 patients before paracetamol administration, median (IQR) systolic blood pressure decreased from the 99^th (95-99) percentile for age before to the 50^th (50-95) percentile after paracetamol (p <0.001) and mean heart rate was 137 bpm before treatment and 115 bpm after (p=0.002). In one patient the hemodynamic event was associated with tachycardia and defined as hypotension, but in no patient did the SBP values drop below the 5^th percentile. Shock, diagnosed on admission in 15 patients, was not associated with a change in the vasoactive-inotropic score after paracetamol administration.

In conclusion, intravenous paracetamol administration was found to be safe in critically ill pediatric patients. It is possible that the observed hemodynamic events were caused by pain relief induced by paracetamol.