Objectives: Acetaminophen is widely used in PICUs. Although randomized
controlled trials suggest that acetaminophen significantly
reduces body temperature in adults, the effect of acetaminophen on
temperature in critically ill children has not been previously quantified.
Design: Retrospective observational cohort study.
Setting: Single-center general and cardiac PICU in a specialist
children’s hospital.
Patients: All children who received acetaminophen or had a fever
(temperature ≥ 38°C) while on the ICU over a 40-month period
(September 2012 to December 2015).
Interventions: None.
Measurements and Main Results: In total, 58,177 doses of acetaminophen
were administered, with temperature data available for
analysis for 54,084 doses. Temperature decreased by 0.11°C (95%
CI, 0.09–0.14°C) 4 hours post acetaminophen dose, after adjustment
for weight and illness severity. In children who had a fever and
were given acetaminophen, temperature decreased by 0.78°C (95%
CI, 0.74–0.82°C). Temperature decreased by 0.88°C (95% CI,
0.85–0.92°C) in children who had fever but did not receive acetaminophen.
The change in temperature associated with fever was
significantly different between those who did and did not receive
acetaminophen (likelihood ratio statistic 246.06; p < 2.2×10–16).
Conclusions: Acetaminophen is associated with a significant
decrease in temperature in children with fever. However, temperature
may decrease following fever without acetaminophen in the
PICU. The threshold to use acetaminophen must be understood
to determine the true effect on temperature in any future trials