Propofol Use Precludes Prescription of Estimated Nitrogen Requirements

Abstract

The objective was to determine whether reducing enteral nutrition to accommodate 1% Propofol-derived energy results in suboptimal nitrogen prescription. This was a prospective observational study of 85 consecutive patients requiring mechanical ventilation and receiving 1% Propofol. Enteral nutrition prescription often failed to meet nitrogen requirements (<90%, in 50.6%; <80%, in 21.1%), whereas fat provided 51% of total energy input, exceeding 2 g fat/kg/d in 20%. However, gastroparesis was common, resulting in suboptimal nutrition (median of requirements: energy 71%; nitrogen 57%). If energy balance had been strictly maintained, substituting 1% with 2% Propofol would reduce the number of patients failing to meet nitrogen requirements (1% vs 2%: <90%: in 58.8% vs 17.6%, P< .001; <80% in 35.3% vs 4.7%, P< .014). These effects are directly related to the amount of fat delivered with Propofol. Intensive care unit-associated gastroparesis commonly reduces enteral nutrition input. However, even where this is overcome, use of 1% Propofol frequently precludes prescription of estimated nitrogen requirements; either 2% Propofol or a non-Propofol alternative should be considered.

Relationship Between Energy Balance and Complications After Subarachnoid Hemorrhage

“…Previous studies in general medical and surgical critical care populations have also demonstrated a large contribution of delivered calories from propofol. 36 Enteral regimens are not routinely altered to account for lipid provisions or to prevent excessive lipid intake. Close supervision of propofol administration as an additional lipid source is clearly warranted in a critically ill population of SAH patients.…”

Does Propofol Sedation Contribute to Overall Energy Provision in Mechanically Ventilated Critically Ill Adults? A Retrospective Observational Study

“…The most frequent reason for ICU admission was major trauma (n = 162, 43.8%). The median [IQR] APACHE II score was 19 [15][16][17][18][19][20][21][22][23][24], 80% required inotropes or vasopressors at some point during their ICU stay, and 65 (17.6%) did not survive to hospital discharge.…”

“…15,16 In an attempt to compensate for energy provided by propofol, EN or PN volumes may be reduced. However this could result in inadequate delivery of protein, 17 particularly as underfeeding is already prevalent in this patient population; average energy delivery in ICUs internationally is reported to be 61%, 3,4 and average protein delivery is approximately 56% or 0.6 g/kg/d. 6 In our study, propofol did contribute a moderate proportion of energy in the first 48 hours, before reaching a stable level by day 3, an observation that is consistent with prior work.…”

Impact of two pulmonary enteral formulations on nutritional indices and outcomes

“…A study by Taylor et al . () found that mechanically‐ventilated ICU patients who were administered propofol received an inadequate amount of protein to meet nitrogen needs at the same time as still maintaining energy balance. The Specialised Group received a statistically significant larger amount of modular protein (4.9 g); however, neither the protein from the modular component, nor the total protein intake had a direct impact on ICU days and the number of ventilator hours in the present study.…”