Predictors of severe hypotension in neurocritical care patients sedated with propofol.
BACKGROUND
Propofol is used extensively in neurocritical care (NCC) due to its pharmacologic properties allowing for facilitation of serial neurologic examinations. Despite widespread use, few studies have identified risk factors for hypotension in these patients. We aimed to determine predictors of hypotension in NCC patients sedated with propofol.


METHODS
This retrospective, multicenter study evaluated 237 patients at two academic medical centers, both with dedicated NCC teams led by board-certified neurointensivists. Univariate analyses were performed to determine risk factors associated with severe hypotension during sedation with propofol. Multivariable analysis was performed to determine variables independently associated with hypotension, defined as a mean arterial pressure (MAP) less than 60 mmHg.


RESULTS
There was an average maximum reduction in MAP of 28.8 % after propofol initiation in the entire cohort. Severe hypotension developed in 62 (26.2 %) patients to a median nadir MAP of 56 mmHg. Those who developed severe hypotension had a longer median duration of mechanical ventilation (5.0 vs. 3.6 days; p = 0.01) and an increased in-hospital mortality (38.7 vs. 24.0 %; p = 0.03). Multivariable logistic regression analysis identified increasing number of changes to the propofol infusion rate, baseline MAP 60-70 mmHg, and need for renal replacement therapy (RRT) as factors independently associated with hypotension.


CONCLUSIONS
Multiple factors predicted hypotension in NCC patients receiving propofol. Clinicians should use propofol cautiously in patients with a lower baseline MAP or receiving RRT. Development of protocols related to the frequency of dose titrations is also recommended to prevent this avoidable complication.
Critical Care Pharmacy, Methodist Healthcare, University Hospital, University of Tennessee Health Sciences Center, 1265 Union Avenue, Memphis, TN, 38104, USA, morgan.jones@mlh.org.
G Morgan
GM
Jones
Bruce A
BA
Doepker
Michael J
MJ
Erdman
Lauren A
LA
Kimmons
Lucas
L
Elijovich
D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects; D062186:Arterial Pressure / Q000187:drug effects*; D015331:Cohort Studies; D003422:Critical Care / Q000592:standards; D004334:Drug Administration Schedule; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007022:Hypotension / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D017582:Renal Replacement Therapy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D000959:Antihypertensive Agents; D006993:Hypnotics and Sedatives; D015742:Propofol