title: Propofol as a Risk Factor for ICU-Acquired Weakness in Septic Patients with Acute Respiratory Failure.
abstract: BACKGROUND
  Critical illness polyneuropathy (CIN) and critical illness myopathy (CIM), together "ICU-Acquired weakness (ICUAW)," occur frequently in septic patients. One of the proposed mechanisms for ICUAW includes prolonged inactivation of sodium channels. Propofol, used commonly in patients with acute respiratory failure (ARF), primarily acts via enhancement of GABAergic transmission but may also increase sodium channel inactivation, suggesting a potential interaction.
  
  
  METHODS
  Electronic medical records and EMG reports of patients with ICUAW and a diagnosis of either sepsis, septicaemia, severe sepsis, or septic shock, concurrent with a diagnosis of acute respiratory failure (ARF), were retrospectively analyzed in a single center university hospital.
  
  
  RESULTS
  74 cases were identified (50.0% men, age 58±14 years), and compared to age- and sex-matched controls. Of these, 51 (69%) had CIN, 19 (26%) had CIM, and 4 (5%) had both. Propofol exposure was significantly higher in patients with ICUAW compared to controls (63.5% vs. 33.8%, p<0.001). The odds ratio of developing ICUAW with propofol exposure was 3.4 (95% CI:1.7-6.7, p<0.001). Patients with ICUAW had significantly more days in hospital (59±44 vs. 30±23) and ICU (38±26 vs. 17±13), days dependent on mechanical ventilation (27±21 vs. 13±16), and rates of tracheostomy (79.7% vs. 36.5%) and gastrostomy (75.7% vs. 25.7%) (all p<0.001). They also received a significantly higher number of distinct intravenous antibiotics, cumulative days of antibiotic therapy, and exposure to vasopressors and paralytics.
  
  
  CONCLUSIONS
  Propofol exposure may increase the risk of ICUAW in septic patients. An interaction through sodium channel inactivation is hypothesized.
authors.affiliation: 1Department of Anesthesia and Critical Care Medicine,Neurocritical Care Division,The Johns Hopkins University School of Medicine,Baltimore,MD.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Abdelmalik
authors.affiliation: 2Department of Neurology,Thomas Jefferson University Hospitals,Philadelphia,PA.
authors.forename: Goran
authors.initials: G
authors.lastname: Rakocevic
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy; D057286:Electronic Health Records / Q000639:trends; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007362:Intensive Care Units / Q000639:trends*; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000139:chemically induced* / Q000453:epidemiology*; D015742:Propofol / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000628:therapy; D015222:Sodium Channels / Q000502:physiology
chemical_list: D006993:Hypnotics and Sedatives; D015222:Sodium Channels; D015742:Propofol
keywords: Critical care; Intensive care; Paralysis; Paresis