Propofol infusion syndrome: a retrospective analysis at a level 1 trauma center.

James H Diaz,Alan David Kaye,Amit Prabhakar,Richard D Urman

doi:10.1155/2014/346968

Abstract

Objectives. The propofol infusion syndrome (PRIS), a rare, often fatal, condition of unknown etiology, is defined by development of lipemic serum, metabolic acidosis, rhabdomyolysis, hepatomegaly, cardiac arrhythmias, and acute renal failure. Methods. To identify risk factors for and biomarkers of PRIS, a retrospective chart review of all possible PRIS cases during a 1-year period was conducted at a level 1 trauma hospital in ICU patients over 18 years of age receiving continuous propofol infusions for ≥3 days. Additional study inclusion criteria included vasopressor support and monitoring of serum triglycerides and creatinine. Results. Seventy-two patients, 61 males (84.7%) and 11 females (15.3%), satisfied study inclusion criteria; and of these, 3 males met the study definition for PRIS, with 1 case fatality. PRIS incidence was 4.1% with a case-fatality rate of 33%. The mean duration of propofol infusion was 6.96 days. A positive linear correlation was observed between increasing triglyceride levels and infusion duration, but no correlation was observed between increasing creatinine levels and infusion duration. Conclusions. Risk factors for PRIS were confirmed as high dose infusions over prolonged periods. Increasing triglyceride levels may serve as reliable biomarkers of impending PRIS, if confirmed in future investigations with larger sample sizes.

Highlights

Propofol is a popular sedative hypnotic commonly used for induction of general anesthesia and sedation in the intensive care unit (ICU)
The term “propofol infusion syndrome” was coined in 1998 when Bray summarized thirteen more propofol-related deaths in children [6]. These children all exhibited a similar constellation of symptoms including metabolic acidosis, lipemic serum, and refractory bradycardia progressing to asystole [7, 8]
The mean duration of propofol infusion in all cases was 6.96 days. Since this was a retrospective review of a cohort of cases sedated with prolonged infusions of propofol and not a prospective observational study of similar cases, the 3 cases meeting the study’s case definition of propofol infusion syndrome (PRIS) would be defined in a traditional manner as a period prevalence of 4.1% and only a reflection of the true incidence of PRIS in a prospective investigation over a one-year period of observation

Summary

Introduction

Propofol is a popular sedative hypnotic commonly used for induction of general anesthesia and sedation in the intensive care unit (ICU). Propofol provides several key physiological benefits that make its use in the ICU favorable including reduced cerebral metabolic demand, anticonvulsive properties, and neuroprotective effects [1]. Despite these advantages, propofol may rarely cause a potentially fatal condition known as propofol infusion syndrome (PRIS). The term “propofol infusion syndrome” was coined in 1998 when Bray summarized thirteen more propofol-related deaths in children [6] These children all exhibited a similar constellation of symptoms including metabolic acidosis, lipemic serum, and refractory bradycardia progressing to asystole [7, 8]. Most of the earlier presenting signs of PRIS in pediatric patients were described including hypoxia, metabolic acidosis, rhabdomyolysis, renal failure, and cardiac dysfunction [8]

Objectives

Methods

Results

Conclusion