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The effects of a single dose of paracetamol in a critical phase of sepsis: a sub-analysis of the PHANTASi trial

  • Author Footnotes
    1 Both authors contributed equally to the manuscript.
    R.S. Nannan Panday
    Footnotes
    1 Both authors contributed equally to the manuscript.
    Affiliations
    Section Acute Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081HZ Amsterdam, The Netherlands

    Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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  • Author Footnotes
    1 Both authors contributed equally to the manuscript.
    M. Schinkel
    Footnotes
    1 Both authors contributed equally to the manuscript.
    Affiliations
    Section Acute Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081HZ Amsterdam, The Netherlands
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  • T. Nutbeam
    Affiliations
    Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, Plymouth Hospitals NHS Trust, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, United Kingdom
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  • N. Alam
    Affiliations
    Section Acute Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081HZ Amsterdam, The Netherlands
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  • P.W.B. Nanayakkara
    Correspondence
    Corresponding author.
    Affiliations
    Section Acute Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081HZ Amsterdam, The Netherlands
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  • Author Footnotes
    1 Both authors contributed equally to the manuscript.
Published:September 11, 2019DOI:https://doi.org/10.1016/j.ejim.2019.08.026
      Sepsis is a life threatening syndrome in which a dysregulated host response to infection leads to life-threatening organ dysfunction [
      • Singer M.
      • Deutschman C.S.
      • Seymour C.W.
      • Shankar-Hari M.
      • Annane D.
      • Bauer M.
      • et al.
      The third international consensus definitions for Sepsis and septic shock (Sepsis-3)consensus definitions for Sepsis and septic ShockConsensus definitions for Sepsis and septic shock.
      ]. In-hospital mortality for patients with sepsis is about 10% [
      • Singer M.
      • Deutschman C.S.
      • Seymour C.W.
      • Shankar-Hari M.
      • Annane D.
      • Bauer M.
      • et al.
      The third international consensus definitions for Sepsis and septic shock (Sepsis-3)consensus definitions for Sepsis and septic ShockConsensus definitions for Sepsis and septic shock.
      ]. Hyperthermia is a common symptom of sepsis, but septic patients with hypothermia have higher mortality rates than patients with hyperthermia [
      • Rumbus Z.
      • Matics R.
      • Hegyi P.
      • Zsiboras C.
      • Szabo I.
      • Illes A.
      • et al.
      Fever is associated with reduced, hypothermia with increased mortality in septic patients: a meta-analysis of clinical trials.
      ]. Thus, fever appears to have a protective role in patients with sepsis. In the Netherlands, some patients with sepsis receive paracetamol in the ambulances, mostly for pain management as fever is not an indication for administration of paracetamol in the Dutch Ambulance Protocol [ ]. As patients with higher temperatures have lower mortality rates, it seems counterintuitive to administer antipyretic drugs.
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