Hypertriglyceridemia: a potential side effect of propofol sedation in critical illness

Abstract

Purpose: Hypertriglyceridemia (hyperTG) is common among intensive care unit (ICU) patients, but knowledge about hyperTG risk factors is scarce. The present study aims to identify risk factors favoring its development in patients requiring prolonged ICU treatment. Methods: Prospective observational study in the medicosurgical ICU of a university teaching hospital. All consecutive patients staying C4 days were enrolled. Potential risk factors were recorded: pathology, energy intake, amount and type of nutritional lipids, intake of propofol, glucose intake, laboratory parameters, and drugs. Triglyceride (TG) levels were assessed three times weekly. Statistics was based on twoway analysis of variance (ANOVA) and linear regression with potential risk factors. Results: Out of 1,301 consecutive admissions, 220 patients were eligible, of whom 99 (45 %) presented hyperTG (triglycerides [2 mmol/L). HyperTG patients were younger, heavier, with more brain injury and multiple trauma. Intake of propofol (mg/kg/h) and lipids' propofol had the highest correlation with plasma TG (r 2 = 0.28 and 0.26, respectively, both p \ 0.001). Infection and inflammation were associated with development of hyperTG [C-reactive protein (CRP), r 2 = 0.19, p = 0.004]. No strong association could be found with nutritional lipids or other risk factors.Outcome was similar in normo-and hyperTG patients. Conclusions: HyperTG is frequent in the ICU but is not associated with adverse outcome. Propofol and accompanying lipid emulsion are the strongest risk factors. Our results suggest that plasma TG should be monitored at least twice weekly in patients on propofol. The clinical consequences of propofol-related hyperTG should be investigated in further studies.

Propofol and perioperative inflammation-the Intralipid® solvent may play a role

“…Long-term administration of propofol was shown to be associated with hypertriglyceridemia [15][16][17]. According to our results such an elevation in the levels of triglycerides begins shortly after an induction dose of propofol or Intralipid 10%…”

“…Long-term propofol sedation has been associated with hypertriglyceridemia [15][16][17], and propofol binds extensively to all lipoprotein fractions [18] including the high density lipoprotein (HDL) fraction. During inflammation, the metabolism of HDL is markedly affected [19], leading to decreasing levels of HDL.…”

A Phase 1c Trial Comparing the Efficacy and Safety of a New Aqueous Formulation of Alphaxalone With Propofol

“…This difference occurred even though the same depth and duration of cortical depression was present in both treatment groups evidenced by the same BIS values shown in Figure 3. The maximum decreases in systolic blood pressure, median (IQR), were 12 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) mm Hg for PHAX and 25 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) mm Hg for propofol and diastolic blood pressure were 14 (9-16) mm Hg for PHAX and 26 (22)(23)(24)(25)(26)(27)(28)(29)(30) mm Hg for propofol. Further, these differences in pressure occurred when the heart rate increases after administration of anesthetic injection, median (IQR) were: 21 (16-24) beats/minute for PHAX and 15 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)…”

“…18 Further, the lipid in that formulation has caused new safety issues with infections, contamination, and lipid toxicity. [19][20][21][22] An alternative excipient for lipid-soluble IV anesthetics is clearly warranted.…”

The truth about nutrition in the ICU

“…Therefore, excessive administration should be avoided. Target calorie intake should be carefully applied, and nonnutritional calories such as propofol should be limited [6]. We recommend not exceeding 35 kcal/kg/day total energy intake, Large observational studies [7] but no prospective randomized controlled trials (PRCTs) have shown the association between negative energy balance and increased rate of complications.…”