Incidence of propofol-related infusion syndrome in critically ill adults: a prospective, multicenter study.
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.
Roberts
Russel J
RJ
Department of Pharmacy, Tufts Medical Center, Boston, MA 02111, USA. rroberts@tuftsmedicalcenter.org
Barletta
Jeffrey F
JF
Fong
Jeffrey J
JJ
Schumaker
Greg
G
Kuper
Philip J
PJ
Papadopoulos
Stella
S
Yogaratnam
Dinesh
D
Kendall
Elise
E
Xamplas
Renee
R
Gerlach
Anthony T
AT
Szumita
Paul M
PM
Anger
Kevin E
KE
Arpino
Paul A
PA
Voils
Stacey A
SA
Grgurich
Philip
P
Ruthazer
Robin
R
Devlin
John W
JW
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
D018686:Anesthetics, Intravenous; D015742:Propofol