Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Houston, TX.
Pharmacy, Texas Children's Hospital, Houston, TX.
Pediatr Crit Care Med. 2019 Jun;20(6):527-533. doi: 10.1097/PCC.0000000000001880.
Acetaminophen is ubiquitously used as antipyretic/analgesic administered IV to patients undergoing surgery and to critically ill patients when enteral routes are not possible. Widely believed to be safe and free of adverse side effects, concerns have developed in adult literature regarding the association of IV acetaminophen and transient hypotension. We hypothesize that there are hemodynamic effects after IV acetaminophen in the PICU and assess the prevalence of such in a large pediatric cardiovascular ICU population using high-fidelity data.
Observational study analyzing an enormous set of continuous physiologic data including millions of beat to beat blood pressures surrounding medication administration.
Quaternary pediatric cardiovascular ICU between January 1, 2013, and November 13, 2017.
All patients less than or equal to 18 years old who received IV acetaminophen. Mechanical support devices excluded.
None.
Physiologic vital sign data were analyzed in 5-minute intervals starting 60 minutes before through 180 minutes after completion. Hypotension defined as mean arterial pressure -15% from baseline and relative hypotension defined -10%. Only doses where patients received no other medications, including vasopressors, within the previous hour were included. t test and a correlation matrix were used to eliminate correlated factors before a logistic regression analysis was performed. Six-hundred eight patients received 777 IV acetaminophen doses. Median age was 8.8 months (interquartile range, 2-62 mo) with a dose of 12.5 mg/kg (interquartile range, 10-15 mg/kg). Data were normalized for age and reference values. One in 20 doses (5%) were associated with hypotension, and one in five (20%) associated with relative hypotension. Univariate analysis revealed hypotension associated with age, baseline mean arterial pressure, and skin temperature (p = 0.05, 0.01, and 0.09). Logistic regression revealed mean arterial pressure (p = 0.01) and age (p = 0.05) remained predictive for hypotension.
In isolation of other medication, a hemodynamic response to IV acetaminophen has a higher prevalence in critically ill children with cardiac disease than previously thought and justifies controlled studies in the perioperative and critical care setting. The added impact on individual patient hemodynamics and physiologic instability will require further study.
对接受手术的患者和无法经肠道途径给药的重症患者，普遍使用对乙酰氨基酚作为解热/镇痛药物进行静脉给药。人们广泛认为对乙酰氨基酚安全且无不良副作用，但成人文献中对静脉用对乙酰氨基酚与短暂性低血压之间的关联产生了担忧。我们假设在 PICU 中使用静脉用对乙酰氨基酚后会产生血流动力学效应，并使用高保真数据评估在大型儿科心血管 ICU 人群中的这种效应的发生率。
分析大量连续生理数据的观察性研究，包括围绕药物给药的数百万次心跳血压数据。
2013 年 1 月 1 日至 2017 年 11 月 13 日期间的四级儿科心血管 ICU。
所有接受静脉用对乙酰氨基酚治疗且年龄小于或等于 18 岁的患者。排除机械支持设备。
无。
在给药前 60 分钟至完成后 180 分钟内，每隔 5 分钟分析生理生命体征数据。将平均动脉压降低 15%定义为低血压，并将相对低血压定义为 -10%。仅纳入患者在过去 1 小时内未接受其他药物（包括血管加压药）的剂量。使用 t 检验和相关矩阵消除相关因素后，进行逻辑回归分析。608 名患者接受了 777 次静脉用对乙酰氨基酚治疗。中位年龄为 8.8 个月（四分位距，2-62 个月），剂量为 12.5mg/kg（四分位距，10-15mg/kg）。数据根据年龄和参考值进行了归一化。20%的剂量与低血压有关，5%的剂量与相对低血压有关。单变量分析显示，低血压与年龄、基础平均动脉压和皮肤温度相关（p=0.05、0.01 和 0.09）。逻辑回归显示，平均动脉压（p=0.01）和年龄（p=0.05）仍然是低血压的预测因素。
在不使用其他药物的情况下，患有心脏病的危重病儿童对静脉用对乙酰氨基酚的血流动力学反应的发生率高于先前的预期，这证明了在围手术期和重症监护环境中进行对照研究是合理的。对个体患者的血流动力学和生理不稳定性的影响需要进一步研究。
