The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019

Abstract

Background: Propofol is commonly used to achieve ventilator synchrony in critically ill patients with coronavirus disease 2019 (COVID-19), yet its safety in this patient population is unknown. Objective: To evaluate the safety, in particular the incidence of hypertriglyceridemia, of continuous infusion propofol in patients with COVID-19. Methods: This was a retrospective study at 1 academic medical center and 1 affiliated teaching hospital in New York City. Adult, critically ill patients with COVID-19 who received continuous infusion propofol were included. Patients who received propofol for <12 hours, were transferred from an outside hospital while on mechanical ventilation, or did not have a triglyceride concentration obtained during the infusion were excluded. Results: A total of 252 patients were included. Hypertriglyceridemia (serum triglyceride concentration ≥ 400 mg/dL) occurred in 38.9% of patients after a median cumulative dose of 4307 mg (interquartile range [IQR], 2448-9431 mg). The median time to triglyceride elevation was 3.8 days (IQR, 1.9-9.1 days). In the multivariable regression analysis, obese patients had a significantly greater odds of hypertriglyceridemia (odds ratio = 1.87; 95% CI = 1.10, 3.21). There was no occurrence of acute pancreatitis. The incidence of possible propofol-related infusion syndrome was 3.2%. Conclusion and Relevance: Hypertriglyceridemia occurred frequently in patients with COVID-19 who received propofol but did not lead to acute pancreatitis. Elevated triglyceride concentrations occurred more often and at lower cumulative doses than previously reported in patients without COVID-19. Application of these data may aid in optimal monitoring for serious adverse effects of propofol in patients with COVID-19.

How to Manage Withdrawal of Sedation and Analgesia in Mechanically Ventilated COVID-19 Patients?

“…The initial analgo-sedation regimen included a combination of propofol (with a maximum of 4 mg/kg·h), sufentanil (0.05 to 0.1 mcg/kg·h with boluses of 0.05 to 0.1 mcg/kg a few minutes before painful procedures) and acetaminophen (1 g q6 h). Although propofol infusion syndrome (PRIS) was quite rare in COVID-19 ARDS patients despite prolonged drug administration [ 21 ], creatine kinase and triglyceride concentrations were measured twice a week in all patients.…”

Comment: The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019

“…1 This article was recently published in Annals of Pharmacotherapy and suggests that obese patients (body mass index [BMI] ≥ 30 kg/ m 2 ) have a high odds ratio (1.87) for hypertriglyceridemia (≥400 mg/dL) during continuous propofol infusion. 1 Although the data regarding the level of sedation induced by propofol dose used in obese and nonobese (BMI < 30 kg/m 2 ) patients with COVID-19 in this report were not presented, one of the putative mechanisms responsible for this result may be as follows 1 : In a retrospective study that examined the effect of obesity (BMI ≥ 30 kg/m 2 ) on propofol dosage (µg/kg/min) required to produce the same level of sedation (Richmond Agitation Sedation Scale [RASS]: 0 to −3) as that induced in nonobese patients undergoing mechanical ventilation for more than 24 hours in an intensive care unit, the initial dosage of propofol in obese patients was found to be lower than that in nonobese (BMI < 30 kg/ m 2 ) patients. 2 Additionally, the median continuous infusion dose of propofol to produce the same level of RASS (0 to −3) was lower in obese patients than in nonobese patients during propofol infusion (2-5 d).…”

Post‑treatment with propofol inhibits inflammatory response in LPS‑induced alveolar type II epithelial cells

“…In clinical practice, patients with inflammation that end up in the operating room or ICU are administered different anesthetics, including propofol. Since the start of the COVID-19 pandemic, an increasing number of patients with preexisting lung injury and inflammation are undergoing surgery or artificial ventilation under sedation at the ICU ( 30 ). In clinical situations, the onset of lung injury usually occurs prior to the administration of anesthesia or sedation to facilitate artificial ventilation.…”