Messina S et al.
Anaesthesia Critical Care & Pain Medicine. 2025;101579. https://doi.org/10.1016/j.accpm.2025.101579
Summary:
This systematic review and meta-analysis evaluated the short-term hemodynamic effects of intravenous paracetamol in critically ill adults. Analyzing eight prospective observational studies (five of which reported mean arterial pressure [MAP]), the study found a significant reduction in MAP (mean difference [MD]: −6.75 mmHg), systolic blood pressure (−11.55 mmHg), and diastolic blood pressure (−5.29 mmHg) within 30 minutes of paracetamol administration. Notably, no significant change in heart rate was observed (MD: −3.08 bpm). The incidence of hypotension post-infusion was reported at 45.5%.
Subgroup analysis indicated that patients receiving paracetamol for fever experienced more pronounced blood pressure reductions than those receiving it for pain. Trial Sequential Analysis (TSA) confirmed the robustness of MAP and diastolic pressure findings, though the overall grade of evidence was deemed “very low” due to confounding factors, heterogeneity, and lack of advanced hemodynamic monitoring in the included studies.
The authors stress the need for more targeted studies to understand the mechanisms of paracetamol-induced hypotension, especially in febrile and hemodynamically unstable ICU patients.
Key takeaways:
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IV paracetamol significantly lowers MAP, SAP, and DAP in critically ill patients.
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No compensatory increase in HR is observed.
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Hypotension occurs in nearly half of patients post-administration.
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Effects are more significant in febrile patients.
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The exact mechanisms remain unclear, and evidence quality is low.
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