Association of preservative-free propofol use and outcome in critically ill patients.
BACKGROUND
Propofol is widely used to provide sedation to patients in the intensive care unit (ICU). This study examined whether preservative-free propofol infusion independently influences outcome in critically ill patients.


METHODS
This was a nested cohort study within a randomized controlled trial. ICU patients who received preservative-free propofol and those who did not were compared. The following data were collected: demographic information, APACHE II score, admission category, chronic severe illnesses, nutritional data, and blood glucose level and insulin dose. The main exposure was the use of preservative-free propofol infusion. The main outcomes were the occurrence of ICU-acquired infections, ICU-acquired sepsis, and ICU and hospital mortality.


RESULTS
A total of 523 patients were included (no propofol group, n = 399; propofol group, n = 124). After adjustment for differences in baseline characteristics, preservative-free propofol use was associated with increased risk of ICU-acquired infections (adjusted odds ratio [aOR], 1.89, 95% confidence interval [CI], 1.17-3.06; P = .009) and ICU-acquired severe sepsis and septic shock (aOR, 1.91; 95% CI, 1.12-3.28; P = .02), but not with ICU or hospital mortality.


CONCLUSIONS
Preservative-free propofol infusion in critically ill patients may be associated with increased risk of ICU-acquired infections and ICU-acquired sepsis, with no significant difference in ICU or hospital mortality. This association might have been related to the use of preservative-free preparations.
Haddad
Samir
S
Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Tamim
Hani
H
Memish
Ziad A
ZA
Arabi
Yaseen
Y
D015331:Cohort Studies; D016638:Critical Illness; D003428:Cross Infection; D004305:Dose-Response Relationship, Drug; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects / Q000737:chemistry; D007362:Intensive Care Units; D008297:Male; D011310:Preservatives, Pharmaceutical / Q000009:adverse effects*; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects / Q000737:chemistry
D006993:Hypnotics and Sedatives; D011310:Preservatives, Pharmaceutical; D015742:Propofol