Acetaminophen and ARDS

Q: There is weak evidence available that the use of acetaminophen may reduce the occurrence of acute respiratory distress syndrome (ARDS) in patients with sepsis and respiratory or circulatory organ failure.

A) True

B) False

Answer: A

An interesting randomized trial of 447 patients was published last month in JAMA, which was conducted from October 2021 to April 2023 with a 90-day follow-up (see reference #1). Patients with sepsis and respiratory or circulatory organ failure, when treated with acetaminophen in a dose of one gram every 6 hours for 5 days, reduce the rate of ARDS. However, there may not be any benefit in days alive and free of organ support - measured for 20 days each.

#pulmonary

#pharmacology

#ARDS

#sepsis

Reference:

1. Ware LB, Files DC, Fowler A, Aboodi MS, Aggarwal NR, Brower RG, Chang SY, Douglas IS, Fields S, Foulkes AS, Ginde AA, Harris ES, Hendey GW, Hite RD, Huang W, Lai P, Liu KD, Thompson BT, Matthay MA; National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network. Acetaminophen for Prevention and Treatment of Organ Dysfunction in Critically Ill Patients With Sepsis: The ASTER Randomized Clinical Trial. JAMA. 2024 May 19. doi: 10.1001/jama.2024.8772. Epub ahead of print. PMID: 38762798.

2. Janz DR, Bastarache JA, Peterson JF, et al. Association between cell-free hemoglobin, acetaminophen, and mortality in patients with sepsis: an observational study. Crit Care Med 2013; 41:784.

3. Suzuki S, Eastwood GM, Bailey M, et al. Paracetamol therapy and outcome of critically ill patients: a multicenter retrospective observational study. Crit Care 2015; 19:162.