Objectives: The use of propofol for continuous sedation in the pediatric population is not commonly practiced. The objective of this study was to evaluate the relationship between propofol administration and Propofol Infusion Syndrome-related (PRIS) characteristics in a single Pediatric Intensive Care setting. Historical reports have suggested that younger age, higher dose, and longer duration are risk factors for PRIS. We hypothesize that continuous propofol infusion is not significantly associated with cardiovascular collapse, metabolic acidosis, or other clinical findings associated with PRIS, even when doses and duration of administration exceed the recommended ranges discussed in the literature. Methods: A retrospective cohort of patients aged 0-17 years admitted into the pediatric intensive care unit (PICU) at the Mayo Clinic in Rochester, MN, from January 2003 through June 2016 with ≥12 hours of propofol intubation were included in the analysis. Data were pulled from METRIC Datamart, an electronic database housing comprehensive data on ICU patients, and manual chart review. Study outcomes included in-hospital mortality, ICU length of stay, bradycardia during infusion, and change in heart rate during infusion. Patient demographics, propofol characteristics, and outcomes were descriptively summarized using counts and percents for categorical variables and medians and quartile ranges for continuous variables. Comparisons in distributions of covariates across categorized age ( < 6 months, 6-12 months, 1-5 years, and 5-17 years) were performed using chi-square/Fisher exact tests and Kruskal-Wallis tests where appropriate. Results: A total of 341 patients met inclusion criteria. The median patient age was 7.5 years and ICU length of stay 5.1 days. The median average infusion rate including boluses was 1.6 mg/kg/hr and the median infusion duration was 21.2 hours. Younger patients had a significantly higher median infusion rate (1.7 mg/kg/hr for < 6 months, 1.9 mg/kg/hr for 6-11.9 months, and 1.8 mg/kg/hr for 1-5 years) than older patients (1.4 mg/kg/hr for 5-17 years, p=0.03), while there was no difference in cumulative dose or time. Patients aged 5-17 had lower median heart rate (HR) during infusion, were more likely to have bradycardia, and had a smaller change in max HR before infusion to lowest HR during infusion than younger patients. There were 9 in-hospital deaths (2.6%) in this group, none of which were attributable to Propofol Infusion Syndrome. Conclusions: The use of propofol infusions in our PICU population largely followed the recommended parameters discussed in the literature of less than 4mg/kg/hr. However, in several cases, propofol infusions were used at higher doses and for longer duration than what has previously been recommended. There were no deaths from PRIS in our population. In our cohort, administration at higher doses for longer durations than has previously been described in the literature was not associated with PRIS.
(76) The Use of Continuous Propofol Infusion in a Pediatric Intensive Care Unit
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Ashley Wong, Grace Arteaga, Chaitanya Undavalli, Rahul Kashyap, Ryan Frank, Sheri Crow; (76) The Use of Continuous Propofol Infusion in a Pediatric Intensive Care Unit. Pediatrics May 2018; 142 (1_MeetingAbstract): 86. 10.1542/peds.142.1MA1.86
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