Propofol sedation substantially increases the caloric and lipid intake in critically ill patients.

Abstract

The amount of lipid delivered to patients varies considerably depending on the non-nutritional intake from sedation, and on the feeding solution. The aim of this study was to quantify the magnitude and proportion of lipids and energy provided from propofol sedation in intensive care unit (ICU) patients. This was a retrospective analysis of prospectively collected data in consecutive patients admitted to the ICUs of two university hospitals. Inclusion criterion included an ICU stay >5d. Data were collected for a maximum of 10d. Propofol sedation using 1% or 2% propofol solutions was defined as >100mg/d. Nutritional management was per protocol in both centers, recommending enteral feeding. Data are shown as means±standard deviation. In all, 701 admissions (687 patients, ages 59±16y, SAPS II 51±17) and 6485d, including 3484 propofol sedation days were analyzed. Energy targets were 1987±411kcal/d; mean energy delivery was 1362±811kcal/d (70%±38% of prescription) including propofol and dextrose. Enteral feeding dominated (75% of days) and progressed similarly in both ICUs. Mean propofol sedation dose was 2045±1650mg/d, resulting in 146±117kcal/d. Fat from propofol constituted 17% of total energy (up to 100% during the first days). Fat delivery (40±23g/d: maximum 310g/d) was significantly increased by the combination of propofol sedation, the 1% solution, and high-fat-containing feeds. In survivors, high-fat proportion was associated with prolonged ventilation time (P<0.0001). Propofol sedation resulted in large doses of lipids being delivered to patients, some receiving pure lipids during the first days. As the metabolic effects of high proportions of fat are unknown, further research is warranted.