1023: IMPACT OF OBESITY ON HEMODYNAMICS IN CRITICALLY ILL PATIENTS RECEIVING PROPOFOL

Abstract

Introduction: Propofol is a commonly used sedative in the ICU, but data on optimal dosing in obese patients is lacking. As propofol is a lipophilic medication, a relatively higher dose based on actual body weight (ABW) may lead to accumulation and increase risk of adverse events. The purpose of this research project is to evaluate the rate of hypotension and bradycardia in critically ill patients receiving propofol for sedation. Methods: This single center, retrospective cohort study examined mechanically ventilated, adult patients receiving continuous sedation with propofol in the ICU from 8/1/16-8/1/21. Patients were excluded if they met the any of the following criteria: propofol dosing not based on ABW, on concomitant vasopressors at time of initiation of propofol, received a bolus dose of propofol, on propofol for < 4 hours, and history of heart block or permanent pacemaker. The primary outcome was the percent of hemodynamic instability during the first 72 hours of propofol administration as defined as hypotension (MAP < 65 mmHg or SBP < 90 mmHg) and bradycardia (heart rate < 60 bpm). Secondary outcomes evaluated include the total dose of propofol (mg) and the degree of hemodynamic instability, defined by the need for intervention (administration of atropine, fluid bolus, vasopressor). All continuous data was expressed as an interquartile range or mean (+/-) standard deviation and analyzed using the independent T-test. Categorical data was expressed as a percent and analyzed using the Chi-Squared test. Results: 331 patients met inclusion criteria (n=171 obese patients, n=160 nonobese patients). Baseline characteristics were similar between the groups, apart from age (61.1±13.9 vs 66.7±13.7, p=< 0.001) and SOFA score (4.3 ± 2.8 vs 2.4 ± 2.5, p< 0.001) More patients in the obese patient group required administrations of a fluid bolus than the non-obese patient group (43.3% vs 28.8%, p< 0.006). Conclusions: The use of ABW in the obese population did not result in a significant association between the occurrence of bradycardia and hypotension, though more obese patients required fluids. Additional studies are needed to confirm this relationship and further explore whether clinical significance exists.