Randomized trial of the effect of antipyresis by metamizol, propacetamol or external cooling on metabolism, hemodynmnics and inflammatory response

Valerio Gozzoli, Miriam Treggiari, Gian Reto Kleger, Pascale Roux-Lombard, Marc Fathi, Claude Pichard, Jacques André Romand

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Objective: We investigated the metabolic, hemodynamic, and inflammatory responses of pharmacological and physical therapies aimed at reducing body temperature in febrile critically ill patients. Design and setting: Open-label, randomized trial in a surgical ICU in a tertiary university hospital. Patients: Thirty analgosedated, mechanically ventilated patients with a temperature of 38.5°C or higher were randomized to receive either intravenous metamizol, intravenous propacetamol, or external cooling. Measurements and results: Body temperature and metabolic and hemodynamic variables were recorded at baseline and during the following 4 h. Cytokine concentrations were assessed before and 4 and 12 h after the initiation of antipyresis. Body temperature decreased significantly in all treatment groups. For a 1°C temperature decrease, the energy expenditure index increased by 5% with external cooling and decreased by 7% and 8% in the metamizol and propacetamol groups, respectively. Metamizol induced a significant decrease in mean arterial pressure and urine output compared to baseline and to the other two groups. C-reactive protein increased over time, but compared to the other groups it was significantly lower in patients receiving metamizol after 4 h. Cytokine concentrations were not different among the three groups or over time, although interleukin 6 tended to decrease over time in the metamizol group. Conclusions: Metamizol, propacetamol, and external cooling equally reduced temperature. Considering the undesirable hemodynamic effects, metamizol should not be considered the first antipyretic choice in unstable patients. Propacetamol or external cooling should be preferred, although the latter should be avoided in patients unlikely to tolerate the increased metabolic demand induced by external cooling.

Original languageEnglish (US)
Pages (from-to)401-407
Number of pages7
JournalIntensive Care Medicine
Volume30
Issue number3
DOIs
StatePublished - Mar 2004
Externally publishedYes

Fingerprint

Dipyrone
Body Temperature
Hemodynamics
Temperature
Cytokines
Antipyretics
propacetamol
Tertiary Care Centers
Critical Illness
C-Reactive Protein
Energy Metabolism
Interleukin-6
Arterial Pressure
Fever
Urine
Pharmacology
Therapeutics

Keywords

  • Adult
  • Cytokines
  • Fever
  • Human
  • Intensive care unit
  • Temperature

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Randomized trial of the effect of antipyresis by metamizol, propacetamol or external cooling on metabolism, hemodynmnics and inflammatory response. / Gozzoli, Valerio; Treggiari, Miriam; Kleger, Gian Reto; Roux-Lombard, Pascale; Fathi, Marc; Pichard, Claude; Romand, Jacques André.

In: Intensive Care Medicine, Vol. 30, No. 3, 03.2004, p. 401-407.

Research output: Contribution to journalArticle

Gozzoli, Valerio ; Treggiari, Miriam ; Kleger, Gian Reto ; Roux-Lombard, Pascale ; Fathi, Marc ; Pichard, Claude ; Romand, Jacques André. / Randomized trial of the effect of antipyresis by metamizol, propacetamol or external cooling on metabolism, hemodynmnics and inflammatory response. In: Intensive Care Medicine. 2004 ; Vol. 30, No. 3. pp. 401-407.
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AU - Kleger, Gian Reto

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AU - Pichard, Claude

AU - Romand, Jacques André

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N2 - Objective: We investigated the metabolic, hemodynamic, and inflammatory responses of pharmacological and physical therapies aimed at reducing body temperature in febrile critically ill patients. Design and setting: Open-label, randomized trial in a surgical ICU in a tertiary university hospital. Patients: Thirty analgosedated, mechanically ventilated patients with a temperature of 38.5°C or higher were randomized to receive either intravenous metamizol, intravenous propacetamol, or external cooling. Measurements and results: Body temperature and metabolic and hemodynamic variables were recorded at baseline and during the following 4 h. Cytokine concentrations were assessed before and 4 and 12 h after the initiation of antipyresis. Body temperature decreased significantly in all treatment groups. For a 1°C temperature decrease, the energy expenditure index increased by 5% with external cooling and decreased by 7% and 8% in the metamizol and propacetamol groups, respectively. Metamizol induced a significant decrease in mean arterial pressure and urine output compared to baseline and to the other two groups. C-reactive protein increased over time, but compared to the other groups it was significantly lower in patients receiving metamizol after 4 h. Cytokine concentrations were not different among the three groups or over time, although interleukin 6 tended to decrease over time in the metamizol group. Conclusions: Metamizol, propacetamol, and external cooling equally reduced temperature. Considering the undesirable hemodynamic effects, metamizol should not be considered the first antipyretic choice in unstable patients. Propacetamol or external cooling should be preferred, although the latter should be avoided in patients unlikely to tolerate the increased metabolic demand induced by external cooling.

AB - Objective: We investigated the metabolic, hemodynamic, and inflammatory responses of pharmacological and physical therapies aimed at reducing body temperature in febrile critically ill patients. Design and setting: Open-label, randomized trial in a surgical ICU in a tertiary university hospital. Patients: Thirty analgosedated, mechanically ventilated patients with a temperature of 38.5°C or higher were randomized to receive either intravenous metamizol, intravenous propacetamol, or external cooling. Measurements and results: Body temperature and metabolic and hemodynamic variables were recorded at baseline and during the following 4 h. Cytokine concentrations were assessed before and 4 and 12 h after the initiation of antipyresis. Body temperature decreased significantly in all treatment groups. For a 1°C temperature decrease, the energy expenditure index increased by 5% with external cooling and decreased by 7% and 8% in the metamizol and propacetamol groups, respectively. Metamizol induced a significant decrease in mean arterial pressure and urine output compared to baseline and to the other two groups. C-reactive protein increased over time, but compared to the other groups it was significantly lower in patients receiving metamizol after 4 h. Cytokine concentrations were not different among the three groups or over time, although interleukin 6 tended to decrease over time in the metamizol group. Conclusions: Metamizol, propacetamol, and external cooling equally reduced temperature. Considering the undesirable hemodynamic effects, metamizol should not be considered the first antipyretic choice in unstable patients. Propacetamol or external cooling should be preferred, although the latter should be avoided in patients unlikely to tolerate the increased metabolic demand induced by external cooling.

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