Research
Incidence of propofol-related infusion syndrome in critically ill adults: a prospective, multicenter study
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* Corresponding author: John W Devlin j.devlin@neu.edu
1 Department of Pharmacy, Tufts Medical Center, 800 Washington Street, mailstop #420, Boston, MA 02111, USA
2 Department of Pharmacy, Spectrum Health, 100 Michigan Street NE (MC01), Grand Rapids, MI 49503, USA
3 Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, 19 Foster Street, Worcester, MA 01608, USA
4 Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
5 Department of Pharmacy, Mayo Clinic College of Medicine, Mayo School of Health Sciences, Siebens Medical Education Building 11200 First Street SW, Rochester, MN 55905, USA
6 Department of Pharmacy, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, USA
7 Department of Pharmacy, University of Massachusetts Memorial Medical Center, 119, Belmont Street, Worcester, MA 01605, USA
8 Department of Pharmacy, Concord Regional Hospital, 250 Pleasant Street, Concord, NH 03301, USA
9 Department of Pharmacy Practice, John H. Stroger Jr. Hospital of Cook County, 1901 W. Harrison Street, Chicago, IL 60612, USA
10 Department of Pharmacy and Center for Critical Care, The Ohio State University Medical Center, 410 West 10thAvenue, Columbus, OH 43210, USA
11 Department of Pharmacy Services, Brigham and Women's Hospital, Pharmacy Administration L-2, 75 Francis Street, Boston, MA 02115, USA
12 Department of Pharmacy, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
13 Stacey Voils, Department of Pharmacy, Virginia Commonwealth University Health System, 410 North 12thStreet, Richmond, VA 23298, USA
14 Institute for Clinical Research and Health Policy Studies, Biostatics Research Center, Tufts Medical Center, 35 Kneeland Street, Boston, MA 02111, USA
15 Northeastern University School of Pharmacy, 360 Huntington Avenue, Mugar 206, Boston, MA 02115, USA
Critical Care 2009, 13:R169 doi:10.1186/cc8145
Published: 29 October 2009Abstract
Introduction
While propofol is associated with an infusion syndrome (PRIS) that may cause death, the incidence of PRIS is unknown. Determining the incidence of PRIS and the frequency of PRIS-related clinical manifestations are key steps prior to the completion of any controlled studies investigating PRIS. This prospective, multicenter study sought to determine the incidence of PRIS and PRIS-related clinical manifestations in a large cohort of critically ill adults prescribed propofol.
Methods
Critically ill adults from 11 academic medical centers administered an infusion of propofol for [>/=] 24 hours were monitored at baseline and then on a daily basis until propofol was discontinued for the presence of 11 different PRIS-associated clinical manifestations and risk factors derived from 83 published case reports of PRIS.
Results
Among 1017 patients [medical (35%), neurosurgical (25%)], PRIS (defined as metabolic acidosis plus cardiac dysfunction and [>/=] 1 of: rhabdomyolysis, hypertriglyceridemia or renal failure occurring after the start of propofol therapy) developed in 11 (1.1%) patients an average of 3 (1-6) [median (range)] days after the start of propofol. While most (91%) of the patients who developed PRIS were receiving a vasopressor (80% initiated after the start of propofol therapy), few received a propofol dose >83 mcg/kg/min (18%) or died (18%). Compared to the 1006 patients who did not develop PRIS, the APACHE II score (25 +/- 6 vs 20 +/- 7, P = 0.01) was greater in patients with PRIS but both the duration of propofol use (P = 0.43) and ICU length of stay (P = 0.82) were similar.
Conclusions
Despite using a conservative definition for PRIS, and only considering new-onset PRIS clinical manifestations, the incidence of PRIS slightly exceeds 1%. Future controlled studies focusing on evaluating whether propofol manifests the derangements of critical illness more frequently than other sedatives will need to be large. These studies should also investigate the mechanism(s) and risk factors for PRIS.