Incidence of propofol-related infusion syndrome in critically ill adults: a prospective, multicenter study

Roberts, Russel J.; Barletta, Jeffrey F.; Fong, Jeffrey; Schumaker, Greg; Kuper, Philip J; Papadopoulos, Stella; Yogaratnam, Dinesh; Kendall, E. J. C.; Xamplas, Renee C.; Gerlach, Anthony T.; Szumita, Paul M.; Anger, Kevin E.; Arpino, Paul A.; Voils, Stacy A.; Grgurich, Philip; Ruthazer, Robin; Devlin, John W.

doi:10.1186/cc8145

Cited by 183 publications

(123 citation statements)

References 67 publications

Supporting

Mentioning

110

Contrasting

Unclassified

Order By: Relevance

“…PRIS is a rare complication, which is associated with high doses (>4 mg/kg/h) and long-term use (>48 h) of propofol, concomitant steroid therapy, high consumption of vasopressors, and patient age <18 years [38,39]. The incidence of PRIS is~1 % in adult patients [40]. There are no valid data for children, but propofol use in children in pediatric intensive care units (PICUs) appeared to be safe when doses did not exceed 4 mg/kg/h and use was restricted to <24 h [41,42].…”

Section: Pathophysiologymentioning

confidence: 99%

Drug-induced acid-base disorders

et al. 2014

View full text Add to dashboard Cite

The incidence of acid-base disorders (ABDs) is high, especially in hospitalized patients. ABDs are often indicators for severe systemic disorders. In everyday clinical practice, analysis of ABDs must be performed in a standardized manner. Highly sensitive diagnostic tools to distinguish the various ABDs include the anion gap and the serum osmolar gap. Drug-induced ABDs can be classified into five different categories in terms of their pathophysiology: (1) metabolic acidosis caused by acid overload, which may occur through accumulation of acids by endogenous (e.g., lactic acidosis by biguanides, propofol-related syndrome) or exogenous (e.g., glycol-dependant drugs, such as diazepam or salicylates) mechanisms or by decreased renal acid excretion (e.g., distal renal tubular acidosis by amphotericin B, nonsteroidal antiinflammatory drugs, vitamin D); (2) base loss: proximal renal tubular acidosis by drugs (e.g., ifosfamide, aminoglycosides, carbonic anhydrase inhibitors, antiretrovirals, oxaliplatin or cisplatin) in the context of Fanconi syndrome; (3) alkalosis resulting from acid and/or chloride loss by renal (e.g., diuretics, penicillins, aminoglycosides) or extrarenal (e.g., laxative drugs) mechanisms; (4) exogenous bicarbonate loads: milk-alkali syndrome, overshoot alkalosis after bicarbonate therapy or citrate administration; and (5) respiratory acidosis or alkalosis resulting from drug-induced depression of the respiratory center or neuromuscular impairment (e.g

show abstract

Section: Pathophysiologymentioning

confidence: 99%

Drug-induced acid-base disorders

et al. 2014

View full text Add to dashboard Cite

show abstract

“…In generale gli agonisti Alfa-2 sembrano inibire la conduttanza ionica attraverso i canali del calcio di tipo L-o P-e facilitare la conduttanza attraverso i canali del potassio calcio-attivati e voltaggio-regolati. Gli effetti degli Alfa-2 agonisti sono facilmente reversibili ad opera degli antagonisti Alfa-2 adrenergici, proprietà che costituisce un indubsi accumulano ad alte dosi [30]. Sulla base delle linee guida disponibili né midazolam né propofol sono raccomandati per la sedazione a lungo termine.…”

Section: Alternative Terapeutiche Disponibili E Unmet Needunclassified

The use of dexmedetomidine in intensive care sedation

Antonelli

Conti

Belisari³

et al. 2013

View full text Add to dashboard Cite

The goals and recommendations for ICU (Intensive Care Unit) patients’ sedation and analgesia should be to have adequately sedated patients who are calm and arousal, so that they can guarantee a proper evaluation and an adequate control of pain. This way, it is also possible to perform their neurological evaluation, preserving intellectual faculties and helping them in actively participating to their care. Dexmedetomidine is a selective alpha-2 receptor agonist, member of theraputical cathegory: “other hypnotics and sedatives” (ATC: N05CM18). Dexmedetomidine is recommended for the sedation of adult ICU patients who need a sedation level not deeper than arousal in response to verbal stimulation (corresponding to Richmond Agitation-Sedation Scale 0 to -3). After the EMA approval, some European government authorities have elaborated HTA on dexmedetomidine, based on clinical evidence derived from Prodex and Midex trials. Dexmedetomidine resulted to be as effective as propofol and midazolam in maintaining the target depth of sedation in ICU patients. The mean duration of mechanical ventilation with dexmedetomidine was numerically shorter than with propofol and significantly shorter than with midazolam. The resulting favourable economic profile of dexmedetomidine supported the clinical use in ICU. Dexmedetomidine seems to provide clinical benefits due to the reduction of mechanical ventilation and ventilator weaning duration. Within the present review, an economic analysis of costs associated to the use of dexmedetomidine was therefore performed also in the Italian care setting. Thus, four different analyses were carried out based on the quantification of the total number of days in ICU, the time spent on mechanical ventilation, the weighted average number of days with mechanical ventilation or not and TISS points (Therapeutic Intervention Scoring System). Despite the incremental cost for drug therapy associated with dexmedetomidine, a reduction of the management costs for ICU has been estimated, with savings ranging between € 800 and € 1,400 per patient.

http://dx.doi.org/10.7175/fe.v14i1S.674

show abstract

“…It is complicated to determine the incidence of propofol-related infusion syndrome (PRIS) because many of the PRIS-associated clinical manifestations may reflect either pharmacologic manifestations of propofol (eg, bradycardia) or manifestations of critical illness (eg, metabolic acidosis). In the first large prospective study involving more than 1000 patients, 3 PRIS was defined as development of metabolic acidosis and cardiac dysfunction after the initiation of propofol along with at least one of the following: rhabdomyolysis, hypertriglyceridemia, or renal failure. Although the study had many limitations, the reported incidence of PRIS was 1.1%.…”

Section: Introductionmentioning

confidence: 99%