Short-term propofol infusion syndrome (PRIS): fact or fiction? A systematic review on early PRIS in intensive care and anesthesia

J Vandenbrande

doi:10.1186/cc14560

Abstract

Propofol infusion syndrome (PRIS) is a rare propofol complication, leading to cardiac failure. It was first described in critically ill children and in adults with traumatic brain injury. Pathophysiology is unknown although common factors are the prolonged (>48 hours) use of high-dose (>5 mg/kg/hour) propofol combined with elevated levels of catecholamines and corticosteroids. Recently, case reports of early-onset PRIS during anesthesia and in the early postoperative setting were published. In many of these, lactic acidosis is interpreted as onset of PRIS. Criticism offers that it might concern a poor differential diagnostic approach or an observational bias. Also, lactic acidosis is not an obligate PRIS symptom and incidence of lactic acidosis during propofol sedation is unknown. To gain insight into the incidence and characteristics of early PRIS, we performed a systematic review on early PRIS cases.

Highlights

To assess cerebral hemodynamics in an experimental sepsis model
Healthy bowel function is an important factor when judging the advisability of early enteral nutrition in critically ill patients
Sepsis is defined as the presence of infection with systemic signs of infection, and severe sepsis as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion [1]

Summary

Introduction

We evaluated platelet activation markers as potential predictive markers of sepsis and of mortality among four commonly encountered populations of patients admitted to ICUs. Methods Ninety-nine non-infected ICU patients were prospectively screened at day 1 (T1) and day 3 (T2) of admission after elective cardiac surgery, trauma, acute neurologic dysfunction or prolonged ventilation (>48 hours). The present study was performed with the aim of assessing whether nursing and physician staff were able to identify patients in need of critical care using only clinical judgment and to compare this with the National Early Warning Score (NEWS) Methods This was a prospective cohort study of all adult patients with a first-time admission to a medical admission unit at a 450-bed regional teaching hospital over a 3-month period in 2010.

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