Long-term sedation with propofol 60 mg ml(-1) vs. propofol 10 mg(-1) ml in critically ill, mechanically ventilated patients.
BACKGROUND
Hypertriglyceridaemia is the main cause of therapeutic failure during propofol use in long-term sedated mechanically ventilated patients. Propofol 60 mg ml(-1) has been developed to reduce fat and volume load for the critically ill patient. The purpose of the study was to compare the effectiveness of sedation, achievability of effective concentrations and the effects on serum lipid concentrations of propofol 60 mg ml(-1) vs. propofol 10 mg ml(-1) for long-term sedation in critically ill patients.


METHODS
In this randomized, open, prospective study, 20 critically ill, mechanically ventilated patients who required sedation for a minimum of 48 h received propofol 60 mg ml(-1) or propofol 10 mg ml(-1) in doses as required during 2-5 days.


RESULTS
No differences between propofol 60 mg ml(-1) and propofol 10 mg ml(-1) were observed in the effectiveness of sedation using the Ramsay Sedation score and the Subjective Sedation score, nor in relation to the propofol concentrations. Between the two groups, there were no significant differences in the daily propofol dose, number of daily infusion rate adjustments or need for additional sedatives. Mean serum triglyceride concentrations were higher in the propofol 10 mg ml(-1) group compared with the propofol 60 mg ml(-1) group [5.26 (3.19) vs. 3.22 (2.05) mmol l(-1), P > 0.05][mean (SD)]. Patients in the propofol 10 mg ml(-1) group received more fat from the propofol infusion than from the propofol 60 mg ml(-1) group [53.2 (29.6) vs. 10.0 (4.7) % compared with fat from nutrition, respectively]. A significant relationship was observed between the daily total fat dose and the serum triglyceride concentration (r2 = 0.32, P < 0.001), whereas there was no significant correlation between the daily propofol dose and the serum triglyceride concentration.


CONCLUSIONS
Propofol 60 mg ml(-1) is a useful alternative to propofol 10 mg ml(-1) for the long-term sedation of critically ill patients. Sedation with propofol 60 mg ml(-1) reduces fat and volume load by 83%, which reduces the risk of hypertriglyceridaemia.
Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, the Netherlands. caj.knibbe@farmacie.rhijnhuysen.net
C A J
CA
Knibbe
H
H
Naber
L P H J
LP
Aarts
P F M
PF
Kuks
M
M
Danhof
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000493:pharmacokinetics; D016292:Procedural Sedation / Q000145:classification; D016638:Critical Illness; D004338:Drug Combinations; D004750:Enteral Nutrition; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D010743:Phospholipids / Q000627:therapeutic use; D015742:Propofol / Q000008:administration & dosage* / Q000493:pharmacokinetics; D011446:Prospective Studies; D012121:Respiration, Artificial; D013012:Sorbitol / Q000627:therapeutic use; D013997:Time Factors; D014280:Triglycerides / Q000097:blood*
D018686:Anesthetics, Intravenous; D004338:Drug Combinations; D005217:Fat Emulsions, Intravenous; D010743:Phospholipids; D014280:Triglycerides; C008288:Lipofundin; D013012:Sorbitol; D015742:Propofol