title: Incidence of propofol-related infusion syndrome in critically ill adults: a prospective, multicenter study.
abstract: BACKGROUND
  While propofol is associated with an infusion syndrome (PRIS) that may cause death, the incidence of PRIS is unknown. Determining the incidence of PRIS and the frequency of PRIS-related clinical manifestations are key steps prior to the completion of any controlled studies investigating PRIS. This prospective, multicenter study sought to determine the incidence of PRIS and PRIS-related clinical manifestations in a large cohort of critically ill adults prescribed propofol.
  
  
  METHODS
  Critically ill adults from 11 academic medical centers administered an infusion of propofol for [>or=] 24 hours were monitored at baseline and then on a daily basis until propofol was discontinued for the presence of 11 different PRIS-associated clinical manifestations and risk factors derived from 83 published case reports of PRIS.
  
  
  RESULTS
  Among 1017 patients [medical (35%), neurosurgical (25%)], PRIS (defined as metabolic acidosis plus cardiac dysfunction and [>or=] 1 of: rhabdomyolysis, hypertriglyceridemia or renal failure occurring after the start of propofol therapy) developed in 11 (1.1%) patients an average of 3 (1-6) [median (range)] days after the start of propofol. While most (91%) of the patients who developed PRIS were receiving a vasopressor (80% initiated after the start of propofol therapy), few received a propofol dose >83 mcg/kg/min (18%) or died (18%). Compared to the 1006 patients who did not develop PRIS, the APACHE II score (25 +/- 6 vs 20 +/- 7, P = 0.01) was greater in patients with PRIS but both the duration of propofol use (P = 0.43) and ICU length of stay (P = 0.82) were similar.
  
  
  CONCLUSIONS
  Despite using a conservative definition for PRIS, and only considering new-onset PRIS clinical manifestations, the incidence of PRIS slightly exceeds 1%. Future controlled studies focusing on evaluating whether propofol manifests the derangements of critical illness more frequently than other sedatives will need to be large. These studies should also investigate the mechanism(s) and risk factors for PRIS.
authors.affiliation: Department of Pharmacy, Tufts Medical Center, Boston, MA 02111, USA. rroberts@tuftsmedicalcenter.org
authors.forename: Russel J
authors.initials: RJ
authors.lastname: Roberts
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Barletta
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Fong
authors.forename: Greg
authors.initials: G
authors.lastname: Schumaker
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Kuper
authors.forename: Stella
authors.initials: S
authors.lastname: Papadopoulos
authors.forename: Dinesh
authors.initials: D
authors.lastname: Yogaratnam
authors.forename: Elise
authors.initials: E
authors.lastname: Kendall
authors.forename: Renee
authors.initials: R
authors.lastname: Xamplas
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Gerlach
authors.forename: Paul M
authors.initials: PM
authors.lastname: Szumita
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Anger
authors.forename: Paul A
authors.initials: PA
authors.lastname: Arpino
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Voils
authors.forename: Philip
authors.initials: P
authors.lastname: Grgurich
authors.forename: Robin
authors.initials: R
authors.lastname: Ruthazer
authors.forename: John W
authors.initials: JW
authors.lastname: Devlin
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D016638:Critical Illness; D005260:Female; D006333:Heart Failure / Q000139:chemically induced; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D013577:Syndrome
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol