{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T16:04:08Z","timestamp":1759939448516,"version":"3.44.0"},"reference-count":15,"publisher":"The Pediatric Pharmacy Association","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Acetaminophen is a commonly administered analgesic and antipyretic medication that is generally well-tolerated. Recent studies in critically ill adults and subsets of pediatric patients with underlying cardiac disease identify an association between adverse hemodynamic effects with intravenous (IV) acetaminophen. However, the data may not be generalizable to a broader population of critically ill children. The objective of this study was to determine the incidence of hemodynamic changes associated with IV acetaminophen administration in critically ill pediatric medical-surgical patients.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This was a retrospective observational study of all patients 18 years of age and younger who received at least 1 dose of IV acetaminophen in a pediatric intensive care unit at a quaternary care medical center, between July and December 2018. The primary outcome was the incidence of hypotension, defined as a decrease in mean arterial pressure (MAP) by at least 15% from baseline. Potential risk factors for IV acetaminophen-associated hypotension were assessed.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 212 patients received 492 doses of IV acetaminophen. The primary endpoint of hypotension occurred following 24% of doses. An intervention for hypotension, primarily fluid resuscitation, was required for 11.9% of the dose-associated hypotension events. Patients receiving vasoactive infusions had more frequent dose-associated hypotension events than those not receiving infusions; however, no other potential risk factors were identified.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The incidence of hypotension observed in critically ill pediatric patients after IV acetaminophen administration is clinically relevant. Large placebo-controlled trial and further study of the risk factors and mechanism of this hemodynamic change are warranted.<\/jats:p>\n <\/jats:sec>","DOI":"10.5863\/1551-6776-28.1.78","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T20:49:13Z","timestamp":1675370953000},"page":"78-83","source":"Crossref","is-referenced-by-count":1,"title":["Incidence of Hemodynamic Changes Following Intravenous Acetaminophen Administration in Critically Ill Pediatric Patients"],"prefix":"10.5863","volume":"28","author":[{"given":"Jimin","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Services (JL, AN, KG), University of California, San Francisco (UCSF) Health, San Francisco, CA"},{"name":"Department of Clinical Pharmacy (JL, AG, KG), School of Pharmacy, University of California, San Francisco, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelica","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Services (JL, AN, KG), University of California, San Francisco (UCSF) Health, San Francisco, CA"},{"name":"Department of Clinical Pharmacy (JL, AG, KG), School of Pharmacy, University of California, San Francisco, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hildy","family":"Schell-Chaple","sequence":"additional","affiliation":[{"name":"Department of Nursing (HSC), University of California, San Francisco, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Pediatric Critical Care (EW, JW), School of Medicine, University of California, San Francisco, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenna","family":"Essakow","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Services (JL, AN, KG), University of California, San Francisco (UCSF) Health, San Francisco, CA"},{"name":"Department of Pediatric Critical Care (EW, JW), School of Medicine, University of California, San Francisco, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kendall","family":"Gross","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Services (JL, AN, KG), University of California, San Francisco (UCSF) Health, San Francisco, CA"},{"name":"Department of Clinical Pharmacy (JL, AG, KG), School of Pharmacy, University of California, San Francisco, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3883","reference":[{"article-title":"Ofirmev [package insert]","year":"2020","key":"i2331-348X-28-1-78-b1","unstructured":"Ofirmev [package insert].\n\t\t\t\t\tHazelwood, MO:\n\t\t\t\t\tMallinckrodt Pharmaceuticals, Inc;\n\t\t\t\t\tJune2020."},{"issue":"7","key":"i2331-348X-28-1-78-b2","series-title":"Crit Care Med","first-page":"1199","article-title":"Effects of IV acetaminophen on core body temperature and hemodynamic responses in febrile critically ill adults: a randomized controlled trial","volume":"45","year":"2017","unstructured":"Schell-Chaple\n HM,\n \n \n Liu\n KD,\n \n \n Matthay\n MA,\n \n \n .\n\t\t\t\t\tEffects of IV acetaminophen on core body temperature and hemodynamic responses in febrile critically ill adults: a randomized controlled trial.\n\t\t\t\t\tCrit Care Med.\n\t\t\t\t\t2017;\n\t\t\t\t\t45(\n\t\t\t\t\t7):\n\t\t\t\t\t1199\u2013\n\t\t\t\t\t1207."},{"issue":"10","key":"i2331-348X-28-1-78-b3","series-title":"Ann Pharmacother","first-page":"1033","article-title":"Intravenous acetaminophen-induced hypotension: a review of the current literature","volume":"3","year":"2019","unstructured":"Maxwell\n EN,\n 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Matousek\n V,\n \n \n Duska\n F.\n \n \n Mechanism of paracetamol-induced hypotension in critically ill patients: a prospective observational cross-over study.\n\t\t\t\t\tAust Crit Care.\n\t\t\t\t\t2013;\n\t\t\t\t\t26(\n\t\t\t\t\t3):\n\t\t\t\t\t136\u2013\n\t\t\t\t\t141."},{"issue":"12","key":"i2331-348X-28-1-78-b8","series-title":"Crit Care Med","first-page":"2192","article-title":"Acetaminophen-induced changes in systemic blood pressure in critically ill patients: results of a multicenter cohort study","volume":"44","year":"2016","unstructured":"Cantais\n A,\n \n \n Schnell\n D,\n \n \n Vincent\n F,\n \n \n .\n\t\t\t\t\tAcetaminophen-induced changes in systemic blood pressure in critically ill patients: results of a multicenter cohort study.\n\t\t\t\t\tCrit Care Med.\n\t\t\t\t\t2016;\n\t\t\t\t\t44(\n\t\t\t\t\t12):\n\t\t\t\t\t2192\u2013\n\t\t\t\t\t2198."},{"issue":"10","key":"i2331-348X-28-1-78-b9","series-title":"Anaesthesia","first-page":"1153","article-title":"Haemodynamic effects of parenteral vs enteral paracetamol in critically ill patients: a randomised controlled trial","volume":"71","year":"2016","unstructured":"Kelly\n SJ,\n \n \n Moran\n JL,\n \n \n Williams\n PJ,\n \n \n .\n\t\t\t\t\tHaemodynamic effects of parenteral vs enteral paracetamol in critically ill patients: a randomised controlled trial.\n\t\t\t\t\tAnaesthesia.\n\t\t\t\t\t2016;\n\t\t\t\t\t71(\n\t\t\t\t\t10):\n\t\t\t\t\t1153\u2013\n\t\t\t\t\t1162."},{"key":"i2331-348X-28-1-78-b10","series-title":"J Crit Care","first-page":"108","article-title":"Haemodynamic changes with paracetamol in critically-ill children","volume":"40","year":"2017","unstructured":"Ray\n S,\n \n \n Brick\n T,\n \n \n Raman\n S,\n \n \n .\n\t\t\t\t\tHaemodynamic changes with paracetamol in critically-ill children.\n\t\t\t\t\tJ Crit Care.\n\t\t\t\t\t2017;\n\t\t\t\t\t40(\n\t\t\t\t\tAug):\n\t\t\t\t\t108\u2013\n\t\t\t\t\t112."},{"issue":"3","key":"i2331-348X-28-1-78-b11","series-title":"Paediatr Drugs","first-page":"177","article-title":"The hemodynamic effect of intravenous paracetamol in children: a retrospective chart review","volume":"21","year":"2019","unstructured":"Nahum\n E,\n \n \n Friedman\n M,\n \n \n Kaplan\n E,\n \n \n .\n\t\t\t\t\tThe hemodynamic effect of intravenous paracetamol in children: a retrospective chart review.\n\t\t\t\t\tPaediatr Drugs.\n\t\t\t\t\t2019;\n\t\t\t\t\t21(\n\t\t\t\t\t3):\n\t\t\t\t\t177\u2013\n\t\t\t\t\t183."},{"year":"2016","series-title":"Pediatric Advanced Life Support: Provider Manual","key":"i2331-348X-28-1-78-b12","unstructured":"Samson\n RA,\n \n \n Schexnayder\n SM,\n \n \n Hazinski\n MF,\n \n \n , eds.\n\t\t\t\t\tPediatric Advanced Life Support: Provider Manual.\n\t\t\t\t\tDallas, TX:\n\t\t\t\t\tAmerican Heart Association;\n\t\t\t\t\t2016."},{"issue":"10","key":"i2331-348X-28-1-78-b13","series-title":"JAMA Pediatr","first-page":"e172352","article-title":"Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the sepsis-3 definitions in critically ill children","volume":"171","year":"2017","unstructured":"Matics\n TJ,\n \n \n Sanchez-Pinto\n LN.\n \n \n Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the sepsis-3 definitions in critically ill children.\n\t\t\t\t\tJAMA Pediatr.\n\t\t\t\t\t2017;\n\t\t\t\t\t171(\n\t\t\t\t\t10):\n\t\t\t\t\te172352."},{"issue":"2","key":"i2331-348X-28-1-78-b14","series-title":"J Pediatr Intensive Care","first-page":"110","article-title":"Sequential organ failure assessment score as a predictor of outcome in sepsis in pediatric intensive care unit","volume":"10","year":"2021","unstructured":"Lalitha\n AV,\n \n \n Satish\n JK,\n \n \n Reddy\n M,\n \n \n .\n\t\t\t\t\tSequential organ failure assessment score as a predictor of outcome in sepsis in pediatric intensive care unit.\n\t\t\t\t\tJ Pediatr Intensive Care.\n\t\t\t\t\t2021;\n\t\t\t\t\t10(\n\t\t\t\t\t2):\n\t\t\t\t\t110\u2013\n\t\t\t\t\t117."},{"issue":"14","key":"i2331-348X-28-1-78-b15","series-title":"J Intensive Care","article-title":"Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support","volume":"8","year":"2020","unstructured":"Nahum\n E,\n \n \n Weissbach\n A,\n \n \n Kaplan\n E,\n \n \n .\n\t\t\t\t\tHemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support.\n\t\t\t\t\tJ Intensive Care.\n\t\t\t\t\t2020;\n\t\t\t\t\t8(\n\t\t\t\t\t14): https:\/\/doi.org\/10.1186\/s40560-020-0430-0"}],"container-title":["The Journal of Pediatric Pharmacology and 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