Common paracetamol may improve recovery in emergency patients

World first research by The George Institute for Global Health, published in The New England Journal of Medicine, has found paracetamol is safe for treating patients in intensive care and may even help them recover and leave hospital quicker.

Dr Manoj Saxena from the Institute said the findings of the study, which was undertaken in partnership with the Medical Research Institute of New Zealand, would influence medical practice around the world.

“Paracetamol is the world’s most commonly administered medicine and has been around for more than 60 years,” Dr Saxena said.

“However, there had been some concern among doctors that the common practice of using it to reduce fever in ICU patients might make them worse.”

Dr Saxena said there was evidence suggesting that fever may help the body combat infection, so it was important to see whether trying to suppress the fever was doing patients more harm than good.

“Clinicians generally give medications like paracetamol or use physical cooling to suppress a fever, primarily because people feel better and it may reduce the “stress” of being unwell,” he said.

“Children with a fever especially look and feel better after taking paracetamol, but no-one has ever tested whether it is safe and effective in treating critically ill patients.

“We showed that paracetamol reduced fever mildly, but more importantly it is safe to use and did not make outcomes worse.

“In fact, in many cases it actually improved outcomes and patients came out of ICU quicker.

“This is important for all Australian families, because it also suggests that paracetamol could help people recover from fever related illness more quickly at home.”

The study used more than 2,500 doctors and nurses from 23 Intensive Care Units across Australia and New Zealand

The research, which was published in the world’s most prestigious medical journal, The New England Journal of Medicine, found:

• Paracetamol was safe and well tolerated in ICU patients with fever or infection
• The medicine reduced body temperature by around a quarter of a degree
• Paracetamol neither improved nor worsened patient outcomes
• Patients spent less time in ICU if they were given paracetamol, but patients who died spent more time in ICU before death if given paracetamol

Director of the Institute’s Critical Care and Trauma Division, Professor John Myburgh AO, said the study suggested that paracetamol could do more than just speed up recovery.

“The results indicate that paracetamol can also delay death in patients who will ultimately die,” Prof Myburgh said.

“While a brief course of paracetamol did not reduce the overall risk of death, the results of this study will prompt further research looking at whether more prolonged courses of paracetamol can reduce the risk of death in patients requiring Intensive Care.”

The study was presented on at the European Society of Intensive Care Medicine Annual Scientific Meeting in Berlin, prior to being published in The New England Journal of Medicine.

The paper Acetaminophen for Fever in Critically Ill Patients with Suspected Infection can be found at www.nejm.org/doi/full/10.1056/NEJMoa1508375.

Leads

• Dr Manoj Saxena

  Post Doctoral Research Fellow