Department of Pharmacy, Texas Children's Hospital, Houston, TX.
Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Pediatr Crit Care Med. 2019 Aug;20(8):e386-e393. doi: 10.1097/PCC.0000000000002072.
To determine the antipyretic efficacy of acetaminophen (IV, enteral, rectal) and ibuprofen (enteral) in critically ill febrile pediatric patients.
Retrospective cohort study.
Quaternary care pediatric hospital ICUs.
Pediatric patients less than 19 years old who were febrile (≥ 38.0°C), received a dose of IV acetaminophen, enteral acetaminophen, rectal acetaminophen, or enteral ibuprofen and had at least one temperature measurement in the following 6 hours.
None.
A total of 3,341 patients (55.8% male, median age 2.5 yr [interquartile range, 0.63-9.2 yr]) met study criteria. Baseline temperature was median 38.6°C (interquartile range, 38.3-38.9°C) measured via axillary (76.9%) route. Patients became afebrile (87.5%) at median 1.4 hours (interquartile range, 0.77-2.3 hr) after the first dose of medication, a -2.9 ± 1.6% change in temperature. Antipyretic medications included as follows: enteral acetaminophen (n = 1,664), IV acetaminophen (n = 682), rectal acetaminophen (n = 637), and enteral ibuprofen (n = 358). Enteral ibuprofen had a significantly greater odds of defervescence on multivariable logistic regression analysis (p = 0.04) with a decrease of -1.97 ± 0.89°C while IV acetaminophen was significant for a decreased time to defervescence at median 1.5 hours (interquartile range 0.8-2.3 hr) after a dose (p = 0.03). Patient age, presence of obesity, and baseline temperature were significant for decreased antipyretic efficacy (p < 0.05).
Enteral ibuprofen was the most efficacious antipyretic and IV acetaminophen had the shortest time to defervescence.
确定在危重症发热儿科患者中使用对乙酰氨基酚（静脉、口服、直肠）和布洛芬（口服）的退热疗效。
回顾性队列研究。
四级儿科医院 ICU。
年龄小于 19 岁的发热（≥38.0°C）患者，接受静脉注射对乙酰氨基酚、口服对乙酰氨基酚、直肠对乙酰氨基酚或口服布洛芬治疗，且在接下来的 6 小时内至少有一次体温测量。
无。
共有 3341 名患者（55.8%为男性，中位年龄 2.5 岁[四分位距 0.63-9.2 岁]）符合研究标准。基础体温通过腋测法测量为中位数 38.6°C（四分位距 38.3-38.9°C）。患者在首次用药后中位 1.4 小时（四分位距 0.77-2.3 小时）达到退热，体温下降-2.9±1.6%。退热药物包括：口服对乙酰氨基酚（n=1664）、静脉注射对乙酰氨基酚（n=682）、直肠对乙酰氨基酚（n=637）和口服布洛芬（n=358）。多变量逻辑回归分析显示，口服布洛芬退热的可能性显著更高（p=0.04），体温下降-1.97±0.89°C，而静脉注射对乙酰氨基酚在剂量后中位 1.5 小时（四分位距 0.8-2.3 小时）退热时间显著缩短（p=0.03）。患者年龄、肥胖存在和基础体温对退热疗效有显著影响（p<0.05）。
口服布洛芬是最有效的解热药，而静脉注射对乙酰氨基酚退热时间最短。
