Fever treatment with acetaminophen fails to reduce time in ICU

Last Updated: 2015-10-05

By Gene Emery

NEW YORK (Reuters Health) - The common practice of using acetaminophen in the intensive care unit to reduce fever caused by a suspected infection did not reduce the time spent in the ICU, according to a test of 700 patients in Australia and New Zealand.

During the first 28 days of therapy, patients in the acetaminophen group had an average of 23 days outside the ICU compared to 22 ICU-free days for the group that received placebo (p=0.07).

By day 90, 15.9% of the acetaminophen recipients had died versus 16.6% in the placebo group (p=0.84).

All were receiving antimicrobial therapy for a known or suspected infection when they were enrolled.

The results of the study, known as HEAT, were published online October 5 in the New England Journal of Medicine and presented at the European Society of Intensive Care Medicine Congress in Berlin by a team led by Dr. Paul Young of Wellington Regional Hospital in New Zealand.

Until now, the evidence has been mixed over whether to give the drug to reduce fever in such cases. Although fever may place additional physiological stress on ICU patients, it may also help the body fight off an infection.

The study was designed with the hypothesis that reducing fever would have a net benefit. Patients with acute brain disorders or liver problems were excluded. Treatment with acetaminophen or placebo was continued for 28 days or until the patient was discharged from the ICU, the fever was resolved, antimicrobial therapy was halted, or some contraindication for the use of the drug developed.

Patients who died during that four-week period were regarded as having no ICU-free days.

The patients receiving acetaminophen had a lower mean peak body temperature and average daily temperature, and 22.8% of the drug recipients saw their fever resolve versus 16.9% of placebo patients (p=0.05).

But mortality rates, ICU length of stay and hospital length of stay were comparable.

However, among the patients who died during the study period, those treated with acetaminophen tended to have a longer length of stay and more ICU time, but the team said that phenomenon needs to be confirmed. The researchers said that trend is consistent with a 2012 study which found that cooling patients to normothermia simply delayed death in septic shock patients receiving mechanical ventilation.

Liver dysfunction prompted doctors to halt fever therapy in a total of 62 patients. The rate of liver-related discontinuation was 9.9% in the placebo group and 8.1% among acetaminophen recipients (p=0.40).

"Our results are generalizable because we studied the broad population of ICU patients with infections who receive acetaminophen to treat fever in routine practice," Dr. Young's team writes.

SOURCE: http://bit.ly/1Z4lbQ7

N Engl J Med 2015.