Mohammad Lana, Al Naeem Waeil, Ramsi Musaab, Al Neyadi Shaikha, Abdullahi Aminu, Rahma Azhar, Dawoud Tasnim Heider
Pharmacy, Shaikh Khalifa Medical City, Abu Dhabi, UAE.
Shaikh Khalifa Medical City, Abu Dhabi, UAE.
Eur J Hosp Pharm. 2024 Dec 30. doi: 10.1136/ejhpharm-2023-004048.
Haemodynamic changes following intravenous acetaminophen are well studied in adults. Limited data are published in critically ill paediatric patients, especially from the Middle East. We aim to investigate haemodynamic effects and incidence of hypotension with intravenous acetaminophen in critically ill children, with a focus on understanding factors influencing these effects.
We retrospectively reviewed patients who received intravenous acetaminophen between July and December 2022. A haemodynamic event was defined as drop of >15% in systolic blood pressure (SBP) or mean arterial blood pressure (MAP) within 120 min after drug administration. Hypotension was defined as either drop in SBP below the 5th percentile for age, or a haemodynamic event associated with tachycardia, increased lactate or treatment with fluid/vasopressors. Logistic regression was performed to quantify relationships between patients' characteristics and the occurrence of haemodynamic event and hypotension.
A haemodynamic event was observed in 50/156 patients (32%) post-acetaminophen. Mean MAP (SD) before and after acetaminophen was 69.6 mm Hg (14.8) and 67.4 mm Hg (13.9), respectively (p=0.001). Mean SBP (SD) before and after acetaminophen was 95.4 mm Hg (18.2) and 92.8 mm Hg (19.2), respectively (p=0.006). Baseline MAP, median (interquartile range (IQR)) was 76.0 (64.0-85.3) and 66.0 (57.0-74.5) in patients with and without haemodynamic events, respectively (p=0.004). Only 38/156 patients (24%) met the definition for hypotension. Baseline MAP, median (IQR) was 62.0 (51.8-79.0) in patients with, and 68.5 (62.0, 79.3) in patients without hypotension (p=0.036). Baseline shock, vasoactives, mechanical ventilation and paediatric sequential organ failure assessment were not significantly associated with hypotension. Only MAP was found to be associated with both haemodynamic event (adjusted odds ratio (AOR) 1.05, 95% CI 1.02-1.10) and hypotension (AOR 1.06, 95% CI 1.02-1.10) even after controlling for other confounders.
Administration of intravenous acetaminophen in critically ill children can lead to haemodynamic changes, including clinically significant hypotensive events.
对成人静脉注射对乙酰氨基酚后的血流动力学变化已进行了充分研究。关于危重症儿科患者的数据有限，尤其是来自中东地区的。我们旨在研究静脉注射对乙酰氨基酚对危重症儿童的血流动力学影响及低血压发生率，重点是了解影响这些影响的因素。
我们回顾性分析了2022年7月至12月期间接受静脉注射对乙酰氨基酚的患者。血流动力学事件定义为给药后120分钟内收缩压（SBP）或平均动脉压（MAP）下降>15%。低血压定义为SBP降至年龄对应的第5百分位数以下，或与心动过速、乳酸升高或使用液体/血管加压药治疗相关的血流动力学事件。进行逻辑回归以量化患者特征与血流动力学事件和低血压发生之间的关系。
50/156例患者（32%）在注射对乙酰氨基酚后出现血流动力学事件。对乙酰氨基酚注射前后的平均MAP（标准差）分别为69.6 mmHg（14.8）和67.4 mmHg（13.9）（p=0.001）。对乙酰氨基酚注射前后的平均SBP（标准差）分别为95.4 mmHg（18.2）和92.8 mmHg（19.2）（p=0.006）。有血流动力学事件的患者基线MAP中位数（四分位间距（IQR））为76.0（64.0 - 85.3），无血流动力学事件的患者为66.0（57.0 - 74.5）（p=0.004）。只有38/156例患者（24%）符合低血压定义。有低血压的患者基线MAP中位数（IQR）为62.0（51.8 - 79.0），无低血压的患者为68.5（62.0，79.3）（p=0.036）。基线休克、血管活性药物使用、机械通气和儿科序贯器官衰竭评估与低血压无显著相关性。即使在控制其他混杂因素后，仅发现MAP与血流动力学事件（调整后比值比（AOR）1.05，95%置信区间1.02 - 1.10）和低血压（AOR 1.06，95%置信区间1.02 - 1.10）均相关。
对危重症儿童静脉注射对乙酰氨基酚可导致血流动力学变化，包括具有临床意义的低血压事件。
