Abstract
Propofol, a commonly used sedative in the intensive care unit, is formulated in a 10% lipid emulsion that contributes 1.1 kcals per mL. As a result, propofol can significantly contribute to caloric intake and can potentially result in complications of overfeeding for patients who receive concurrent enteral or parenteral nutrition therapy. In order to avoid potential overfeeding, some clinicians have empirically decreased the infusion rate of the nutrition therapy, which also may have detrimental effects since protein intake may be inadequate. The purpose of this review is to examine the current literature regarding these issues and provide some practical suggestions on how to restrict caloric intake to avoid overfeeding and simultaneously enhance protein intake for patients who receive either parenteral or enteral nutrition for those patients receiving concurrent propofol therapy.
Highlights
Propofol is a commonly used intravenous sedative for ventilator-dependent patients.Its advantage over other sedative agents, such as benzodiazepines, is in its rapid onset and short half-life which allows for daily awakening and spontaneous breathing trials.The use of propofol is recommended by the Brain Trauma Foundation for the treatment of elevated intracranial pressure [1] and sometimes prolonged continuous large doses are required
The intent of this review is to examine caloric intake associated with propofol therapy and to describe some strategies to avoid overfeeding that will still meet the increased protein needs of critically ill patients who require enteral nutrition (EN) or parenteral nutrition (PN) therapy
Most of the reports studied propofol use in a heterogenous intensive care unit (ICU) patient population; some studies were focused upon a select patient population such as trauma and neurosurgical patients [6,12,15], COVID-19 patients [7], or those receiving extracorporeal membrane oxygenation [10]
Summary
Propofol is a commonly used intravenous sedative for ventilator-dependent patients. The use of propofol is recommended by the Brain Trauma Foundation for the treatment of elevated intracranial pressure [1] and sometimes prolonged continuous large doses are required. Prolonged use of large doses can be problematic in the nutritional management of these patients since propofol is formulated in a 10% lipid emulsion as either soybean oil in the United States or available in a mixed oil formulation internationally. Complications associated with caloric overfeeding, hypertriglyceridemia, and inadequate protein intake may occur for patients receiving propofol therapy [2]. The intent of this review is to examine caloric intake associated with propofol therapy and to describe some strategies to avoid overfeeding that will still meet the increased protein needs of critically ill patients who require enteral nutrition (EN) or parenteral nutrition (PN) therapy
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