Comparison of the effects of paracetamol, metamizol and external cooling on the fever reduction in intensive care unit patients

Introduction: Fever is a common clinical finding in hospitalized patients. Fever is observed in 90% of patients in the intensive care unit (ICU) and may be associated with increased morbidity and mortality. Antipyretic treatments are effective in lowering the temperature, but may have significant side effects. In this study, we compared the antipyretic effects of paracetamol, metamizol and external cooling, which are frequently used for treatment of fever in ICU patients, and also evaluated the effects and side effects of these methods on hemodynamics. Material and Method: Design of study: Retrospective study in Anesthesiology and Reanimation ICU of Gaziantep University hospital. Patient population: We studied 500 patients who had a febrile episode (>38.3°C): 167 received paracetamol, 167 metamizol and 166 external cooling. Body temperature, systolic, diastolic and mean arterial pressure, heart rate, oxygen saturation and diuresis of the patients were determined at baseline and at 30, 60 and 120 minutes after infusion of the drugs. Results: Patient characteristics, baseline temperature and hemodynamics were similar in all the groups. There was a significant decrease in fever in all 3 groups (p=0.001). When we compared these groups, we found that patients who recieved metamizol had a higher temperature decrease than paracetamol and external cooling groups (p=0.001). After 120 minutes, the mean decrease in mean arterial pressure was 3.99 ± 8.95 mmHg with paracetamol, 4.54 ± 8.60 mmHg with metamizol, and 2.79 ± 10.45 mmHg with external cooling (p = 0.001). Conclusion: Metamizol was the most effective antipyretic agent at the doses tested. All three methods reduced mean arterial pressure. Therefore, the benefits and risks of antipyretic treatment should be taken into account when planning treatment in critically ill patients. Keywords: fever, intensive care unit, paracetamol, metamizol, external cooling