심혈관계 중환자에서 Propacetamol과 Acetaminophen 주사제의 저혈압 발생 비교
Hypotension Incidence with Intravenous Propacetamol vs Acetaminophen in the Heart Intensive Care Unit
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Background : Hypotension is a well known adverse effect of intravenous propacetamol and acetaminophen. Specially, it increases mortality, acute renal failure, and myocardial injury in intensive care units. However, there is limited data comparing hypotension incidences caused by intravenous propacetamol and acetaminophen. The purpose of this study was to investigate the incidences and risk factors of propacetamol- and acetaminophen-associated hypotension. Methods : From January 1, 2019 June 30, 2019, we retrospectively reviewed the electronic medical records of the heart intensive care unit (HICU) patients who received intravenous propacetamol or acetaminophen. Hypotension was defined as systolic blood pressure (SBP) <90 mmHg, a SBP decrease >30 mmHg from the baseline, or a >15% decrease in mean arterial pressure (MAP) within two hours after the first administration. Also, we identified the risk factors of hypotension in the hypotension incidence group by comparing with the control group. Results : We reviewed 98 patients on intravenous propacetmaol and 106 patients on intravenous acetaminophen. There was no significant difference in the hypotension incidence in both groups. However, the incidence of hypotension within one hour of administration was significantly higher in the propacetamol group (21.4%) than in the acetaminophen group (9.4%) (p=0.017). The risk factor analysis indicated that low albumin level (<3 g/dL) (OR: 2.847, 95% CI: 1.339-6.054, p=0.007) and high initial SBP (≥140 mmHg) (OR: 3.142, 95% CI: 1.304-7.574, p=0.011) highly correlated with hypotension incidence. Conclusion : The critically ill patients may have a potential risk of hypotension when administered propacetamol or acetaminophen. Thus, in critically ill patients, we highly recommend caution when administering these medications as well as essential blood pressure (BP) monitoring. The patients with low albumin level or high initial SBP may increase the risk of hypotension. Thus, we strongly close BP monitoring in high risk group patients.
Abstract
Background : Hypotension is a well known adverse effect of intravenous propacetamol and acetaminophen. Specially, it increases mortality, acute renal failure, and myocardial injury in intensive care units. However, there is limited data comparing hypotension incidences caused by intravenous propacetamol and acetaminophen. The purpose of this study was to investigate the incidences and risk factors of propacetamol- and acetaminophen-associated hypotension. Methods : From January 1, 2019 June 30, 2019, we retrospectively reviewed the electronic medical records of the heart intensive care unit (HICU) patients who received intravenous propacetamol or acetaminophen. Hypotension was defined as systolic blood pressure (SBP) <90 mmHg, a SBP decrease >30 mmHg from the baseline, or a >15% decrease in mean arterial pressure (MAP) within two hours after the first administration. Also, we identified the risk factors of hypotension in the hypotension incidence group by comparing with the control group. Results : We reviewed 98 patients on intravenous propacetmaol and 106 patients on intravenous acetaminophen. There was no significant difference in the hypotension incidence in both groups. However, the incidence of hypotension within one hour of administration was significantly higher in the propacetamol group (21.4%) than in the acetaminophen group (9.4%) (p=0.017). The risk factor analysis indicated that low albumin level (<3 g/dL) (OR: 2.847, 95% CI: 1.339-6.054, p=0.007) and high initial SBP (≥140 mmHg) (OR: 3.142, 95% CI: 1.304-7.574, p=0.011) highly correlated with hypotension incidence. Conclusion : The critically ill patients may have a potential risk of hypotension when administered propacetamol or acetaminophen. Thus, in critically ill patients, we highly recommend caution when administering these medications as well as essential blood pressure (BP) monitoring. The patients with low albumin level or high initial SBP may increase the risk of hypotension. Thus, we strongly close BP monitoring in high risk group patients.
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