Safety of Extended Propofol Infusions in Critically Ill Pediatric Patients

TL;DR

This study examines the safety of long-term propofol use in critically ill children and finds no cases of a serious side effect called PRIS.

Contribution

The study provides pilot data on extended propofol infusions in critically ill pediatric patients, highlighting the need for further research.

Findings

No cases of propofol-related infusion syndrome (PRIS) were observed in patients receiving high-dose propofol.

Demographics were similar between groups, but illness severity and vasoactive support varied with infusion duration.

Lactate levels and biochemical markers showed no major differences between short- and long-term infusion groups.

Abstract

Introduction

Propofol is a phenol agent with sedative and anesthetic properties that has been in use for decades, but with controversy in critically ill pediatric patients, given the concern for developing propofol-related infusion syndrome (PRIS). Our aim was to assess the risk of propofol infusions in the pediatric intensive care unit (PICU) at doses and durations greater than the described safety data and its associated covariables.

Methods

Retrospective cohort analysis of 173 patients receiving propofol in the PICU. Patients were categorized as receiving greater or less than 48-hour infusions. Demographic data and daily clinical variables were recorded for up to seven days post-infusion initiation or until infusion was stopped.

Results

In this descriptive analysis, patients’ demographics were similar, but admission diagnosis was not. Both groups received high mean doses of propofol (>67 mcg/kg/min), with no cases of PRIS observed. The illness severity scores and the need for vasoactive infusion support varied between the cohorts, with higher illness scores and a higher percentage of subjects requiring vasoactive agents in the >48-hour cohort. Finally, there were no major differences in lactate levels or biochemical characteristics between the two groups.

Conclusions

This study provides pilot data in relation to the feasibility of propofol infusion in critically ill pediatric patients and underscores the need for a larger multicenter study to draw clinical recommendations.

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