Permissive HyperthErmia Through Avoidance of Paracetamol in Known or Suspected Infection in the Intensive Care Unit (ICU) - pilot study

After randomisation, the patient will receive 1gm of IV paracetamol or placebo 6 hourly until one of the following occurs: 1. the patient ceases antimicrobial therapy 2. the patient is discharged from ICU 3. the patient is deemed to have completed the course of study medication (as described below) Provided that the patient remains on antimicrobial therapy and remains in ICU, they will receive paracetamol or placebo until at least the morning of study day 2. On the morning of study day 2, the research co-ordinator will assess the patient. If the patient has not had a standardised body temperature of <37.5 degrees for the previous 24 hours, they will continue to receive paracetamol or placebo 6 hourly and will be assessed by the research co-ordinator on each subsequent morning to determine if they have had a standardised body temperature of <37.5 degrees for the previous 24 hours. If, at the time of assessment by the research co-ordinator, the patient has had a standardised body temperature of <37.5 degrees for the entire past 24 hours, further study treatment will be withheld. If the patient does not develop a fever of >37.9 degrees within 48 hours from the time of assessment by the research co-ordinator, they will be deemed to have completed the course of study medication. If the patient does develop another standardised body temperature of >37.9 degrees , the patient will restart study medication and, thereafter, they will be assessed each morning by the research co-ordinator to determine whether they a have had a standardised body temperature of <37.5 degrees for a period of 24 hours at which point medication will be withheld and then stopped as described above. Once the patient has completed the course of study medication, they may receive open label paracetamol at the discretion of the treating clinician.