Paracetamol in intensive care – intravenous, oral or not at all?

Hanks, F. and McKenzie, C. (2016) Paracetamol in intensive care – intravenous, oral or not at all? Anaesthesia, 71 (10), 1136-1140. (doi:10.1111/anae.13517).

Record type: Article

Abstract

Kelly et al. have published a study in this edition of Anaesthesia that sought to quantify the hypotensive effect of oral/enteral vs. parenteral paracetamol 1. In addition, it described the pharmacokinetic (PK) data of parenteral and oral/enteral formulations of paracetamol in critical care patients, as well as its effect on pain and temperature. The results of this study pose some interesting questions over both the choice of prescribing route in critical care and the necessity of paracetamol prescription.

Paracetamol is one of the most widely prescribed medications within critical care, with a large observational trial reporting that 64% of intensive care unit (ICU) patients received paracetamol during their stay 2. The Guy's and St Thomas’ Critical Care Units (54 level 3 beds) use approximately 8500 parenteral doses and 16,000 oral/enteral doses per annum. While it is not a high-cost medication (~£4000-4500 UK, $5500-6000 US, € 5000-5500 per annum), its prescription is ubiquitous. This study by Kelly et al., as well as recent data from the HEAT Trial 3, questions whether the risk–benefit analysis of prescribing paracetamol within critical care should be re-evaluated. In addition, when paracetamol is indicated, is it administered via the correct route?

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