[Hemodynamic and antipyretic effects of paracetamol, metamizol and dexketoprofen in critical patients].

BACKGROUND The objective was to study the antipyretic and hemodynamic effects of three different drugs used to treat fever in critically ill patients. METHODS DESIGN AND SETTING Prospective, observational study in a 16-bed, general ICU of a university hospital. PATIENT POPULATION We studied 150 patients who had a febrile episode (temperature>38°C): 50 received paracetamol, 50 metamizol and 50 dexketoprofen. INTERVENTIONS None. Body temperature, systolic, diastolic and mean arterial pressure, heart rate, central venous pressure and oxygen saturation were determined at baseline and at 30, 60 and 120minutes after infusion of the drug. Additionally, we recorded temperature 180minutes after starting drug infusion. Diuresis and the need for or change of dose of vasodilator or vasoconstrictor drugs were also recorded. RESULTS Patient characteristics, baseline temperature and hemodynamics were similar in all groups. We observed a significant decrease of at least 1°C in temperature after 180minutes in 38 patients treated with dexketoprofen (76%), in 36 with metamizol (72%), and in 20 with paracetamol (40%) (p<0.001). After 120minutes, the mean decrease in mean arterial pressure was 8.5±13.6mmHg with paracetamol, 14.9±11.8mmHg with metamizol, and 16.8±13.7mmHg with dexketoprofen (p=0.005). CONCLUSIONS Dexketoprofen was the most effective antipyretic agent at the doses tested. Although all three drugs reduced mean arterial pressure, the reduction with paracetamol was less pronounced.