Lee Jimin, Ng Angelica, Schell-Chaple Hildy, Wong Erika, Essakow Jenna, Gross Kendall
Department of Pharmaceutical Services (JL, AN, KG), University of California, San Francisco (UCSF) Health, San Francisco, CA.
Department of Clinical Pharmacy (JL, AG, KG), School of Pharmacy, University of California, San Francisco, CA.
J Pediatr Pharmacol Ther. 2023;28(1):78-83. doi: 10.5863/1551-6776-28.1.78. Epub 2023 Feb 3.
Acetaminophen is a commonly administered analgesic and antipyretic medication that is generally well-tolerated. Recent studies in critically ill adults and subsets of pediatric patients with underlying cardiac disease identify an association between adverse hemodynamic effects with intravenous (IV) acetaminophen. However, the data may not be generalizable to a broader population of critically ill children. The objective of this study was to determine the incidence of hemodynamic changes associated with IV acetaminophen administration in critically ill pediatric medical-surgical patients.
This was a retrospective observational study of all patients 18 years of age and younger who received at least 1 dose of IV acetaminophen in a pediatric intensive care unit at a quaternary care medical center, between July and December 2018. The primary outcome was the incidence of hypotension, defined as a decrease in mean arterial pressure (MAP) by at least 15% from baseline. Potential risk factors for IV acetaminophen-associated hypotension were assessed.
A total of 212 patients received 492 doses of IV acetaminophen. The primary endpoint of hypotension occurred following 24% of doses. An intervention for hypotension, primarily fluid resuscitation, was required for 11.9% of the dose-associated hypotension events. Patients receiving vasoactive infusions had more frequent dose-associated hypotension events than those not receiving infusions; however, no other potential risk factors were identified.
The incidence of hypotension observed in critically ill pediatric patients after IV acetaminophen administration is clinically relevant. Large placebo-controlled trial and further study of the risk factors and mechanism of this hemodynamic change are warranted.
对乙酰氨基酚是一种常用的止痛和解热药物，通常耐受性良好。最近针对危重症成人及患有潜在心脏病的儿科患者亚组开展的研究发现，静脉注射对乙酰氨基酚会产生不良血流动力学效应。然而，这些数据可能无法推广至更广泛的危重症儿童群体。本研究的目的是确定在危重症儿科内科-外科患者中，静脉注射对乙酰氨基酚后发生血流动力学变化的发生率。
这是一项回顾性观察研究，研究对象为2018年7月至12月期间在一家四级医疗中心的儿科重症监护病房接受至少1剂静脉注射对乙酰氨基酚的所有18岁及以下患者。主要结局是低血压的发生率，低血压定义为平均动脉压（MAP）较基线水平至少降低15%。评估了静脉注射对乙酰氨基酚相关低血压的潜在风险因素。
共有212例患者接受了492剂静脉注射对乙酰氨基酚。24%的剂量注射后出现了主要终点低血压情况。在11.9%的剂量相关低血压事件中，需要进行针对低血压的干预，主要是液体复苏。接受血管活性药物输注的患者发生剂量相关低血压事件的频率高于未接受输注的患者；然而，未发现其他潜在风险因素。
危重症儿科患者静脉注射对乙酰氨基酚后观察到的低血压发生率具有临床相关性。有必要开展大型安慰剂对照试验，并进一步研究这种血流动力学变化的风险因素和机制。
