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Risk Factors for Intravenous Propacetamol-Induced Blood Pressure Drop in the Neurointensive Care Unit: A Retrospective Observational Study

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Abstract

Background

Intravenous propacetamol is commonly used to control fever and pain in neurocritically ill patients in whom oral administration is often difficult. However, several studies reported that intravenous propacetamol may cause blood pressure drop. Thus, we aimed to investigate the occurrence and risk factors for intravenous propacetamol-induced blood pressure drop in neurocritically ill patients.

Methods

This retrospective study included consecutive patients who were administered intravenous propacetamol in a neurointensive care unit at a single tertiary academic hospital between April 2013 and June 2020. The exact timing of intravenous propacetamol administration was collected from a database of the electronic barcode medication administration system. Blood pressure drop was defined as a systolic blood pressure below 90 mm Hg or a decrease by 30 mm Hg or more. Blood pressure, pulse rate, and body temperature were collected at baseline and within 2 h after intravenous propacetamol administration. The incidence of blood pressure drop was evaluated, and multivariable logistic regression analysis was performed to identify risk factors for blood pressure drop events.

Results

A total of 16,586 instances of intravenous propacetamol administration in 4916 patients were eligible for this study. Intravenous propacetamol resulted in a significant decrease in systolic blood pressure (baseline 131.1 ± 17.8 mm Hg; within 1 h 124.6 ± 17.3 mm Hg; between 1 and 2 h 123.4 ± 17.4 mm Hg; P < 0.01). The incidence of blood pressure drop events was 13.5% within 2 h after intravenous propacetamol. Older age, lower or higher baseline systolic blood pressure, fever, higher Acute Physiology and Chronic Health Evaluation II score, and concomitant administration of vasopressors/inotropes or analgesics/sedatives were significant factors associated with the occurrence of blood pressure drop events after intravenous propacetamol administration.

Conclusions

Intravenous propacetamol can induce hemodynamic changes and blood pressure drop events in neurocritically ill patients. This study identified the risk factors for blood pressure drop events. On the basis of our results, judicious use of intravenous propacetamol is warranted for neurocritically ill patients with risk factors that make them more susceptible to hemodynamic changes.

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Acknowledgements

The authors thank the Division of Statistics in Medical Research Collaborating Center at Seoul National University Bundang Hospital for statistical analysis.

Funding

This research was supported by the National Research Foundation of Korea, funded by the Ministry of Science and ICT (Grant NRF-2020M3E5D9079768).

Author information

Author notes

  1. Eunah Lee and Young Joo Song contributed equally to this work.

Authors and Affiliations

  1. Department of Pharmacy, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13620, Republic of Korea

    Eunah Lee, Young Joo Song, Sujeong Jeon, Junghwa Lee & Eunsook Lee

  2. College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea

    Ju-Yeun Lee & Euni Lee

  3. Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, 08826, Republic of Korea

    Moon-Ku Han & Han-Gil Jeong

  4. Division of Neurocritical Care, Department of Neurosurgery and Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea

    Han-Gil Jeong

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  1. Eunah Lee
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Contributions

EL and YJS performed data collection, data analysis, manuscript preparation, and the revision of the content. SJ, JL, EL, J-YL, EL, and M-KH performed data collection, data analysis, and critical review. H-GJ performed the conceptualization and design of the work, statistical analysis, manuscript preparation, and the critical revision of the content. All authors revised and approved the submitted manuscript.

Corresponding author

Correspondence to Han-Gil Jeong.

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There are no conflicts of interest to declare.

Ethical approval/informed consent

This retrospective study was approved by the Institutional Review Board of Seoul National University Bundang Hospital (B-2008/633-106). Patient consent was waived by the institutional review board because of its retrospective nature and minimal risk for patients.

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Lee, E., Song, Y.J., Jeon, S. et al. Risk Factors for Intravenous Propacetamol-Induced Blood Pressure Drop in the Neurointensive Care Unit: A Retrospective Observational Study. Neurocrit Care 36, 888–896 (2022). https://doi.org/10.1007/s12028-021-01390-2

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  • DOI: https://doi.org/10.1007/s12028-021-01390-2

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