# The safety of high dose continuous propofol infusion in the pediatric intensive care unit at an academic medical center

## TL;DR

This study examines the safety of high-dose propofol in critically ill children and finds that PRIS is rare, supporting its use with proper monitoring.

## Contribution

The study provides empirical evidence on the safety of high-dose propofol in pediatric ICU settings, addressing concerns about PRIS.

## Key findings

- Only one case of PRIS was observed among 554 patients.
- Propofol was associated with a low incidence of metabolic acidosis and bradycardia.
- In-hospital deaths were not attributed to PRIS.

## Abstract

Adequate sedation is crucial in the care of critically ill children. Propofol, known for its rapid onset, reliable patient response, and short duration of action, offers an attractive pharmacologic profile. However, concerns for propofol-related infusion syndrome (PRIS) have limited its use in pediatric critical care. This study examined the relationship between propofol administration and PRIS characteristics in a single medical-surgical pediatric intensive care unit (PICU). We hypothesized that continuous propofol infusion, even when judiciously exceeding current recommended doses and durations, is not associated with cardiovascular collapse, metabolic acidosis, or other PRIS-related characteristics.

This is a retrospective single-center study in the non-cardiac medical/surgical PICU at a tertiary academic medical center of 554 patients. Children aged 0–17 years admitted to the PICU from 1/1/2000 to 9/30/2024, who received propofol infusions for ≥12 h and/or ≥2.4 mg/kg/hour (40 mcg/kg/min) were included. The primary outcome was in-hospital mortality; secondary outcomes included intensive care unit (ICU) length of stay, bradycardia during infusion, and metabolic acidosis during infusion. Data was compared across age groups (<6 months, 6–12 months, 1–5 years, 6–17 years) and medical/surgical diagnosis using the chi-square test for homogeneity and the Kruskal–Wallis tests.

Among 554 patients, the median age was 5.5 (IQR 1.5–12.1) years. The median propofol infusion rate was 3.0 (IQR 1.7–4.2) mg/kg/hour [50 (IQR 28–70) mcg/kg/min], median duration was 22.8 (IQR 16.4–42.4) hours, and median ICU length of stay was 4.7 (IQR 2.0–10.4) days. One case of PRIS was observed (0.2%). There were 26 (4.7%) in-hospital deaths, nonattributable to PRIS. Bradycardia occurred in 146 (26.4%) patients, and 19 (3.4%) patients developed metabolic acidosis.

In this single-center retrospective study, one case of PRIS was identified. While rare, its occurrence underscores the need for vigilance. Propofol remains a viable sedation option when used with appropriate monitoring in pediatric critical care.