PulmCrit (EMCrit)
PulmCrit - March 11, 2019 - By Josh Farkas
"Summary: The Bullet
- Acetaminophen has previously been shown to be an effective analgesic which can reduce opioid consumption.
- DEXACET shows that in a cohort of critically ill post-cardiothoracic surgery patients, IV acetaminophen reduced the incidence of delirium. This suggests that acetaminophen use may offer meaningful, patient-oriented benefit.
- Although DEXACET was performed with IV acetaminophen, other studies have found equivalent efficacy between either oral or intravenous forms.
- Acetaminophen is probably an under-utilized analgesic among critically ill patients. For maximal efficacy, oral acetaminophen should be given in substantial doses in a scheduled fashion (e.g. 1 gram q6-q8 hours scheduled, not 650 mg q8hr PRN).
- DEXACET isn’t incredibly robust statistically (fragility index of two). However, it validates longstanding principles of analgesia (specifically, the “analgesic ladder”). Until further evidence is available, it’s sensible to use these principles in clinical practice. This isn’t a revolution, but rather a reminder of first principles."