(994) Safety and Efficacy of Propofol Infusions as an Adjunct Sedative in Critically Ill Children

Introduction: The use of propofol has traditionally been limited in the pediatric population due to risk of propofol related infusion syndrome (PRIS). Recent studies have challenged this notion, and the 2022 Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients with Consideration of the ICU Environment and Early Mobility (PANDEM) guidelines suggest that propofol may be a safe and effective option if utilized at appropriate doses for short durations. We sought to evaluate the safety and efficacy of propofol use for non-procedural sedation in critically ill children.

Methods: This retrospective study included mechanically ventilated pediatric patients ( < 18 years) who received propofol for at least 12 hours in the pediatric intensive care unit or pediatric cardiac intensive care unit within a single institution. The primary endpoint was the development of PRIS, defined as positive physician review for PRIS or documented concern for PRIS. Patients with development of unexplained metabolic acidosis, cardiac dysfunction and one other abnormal marker indicative of PRIS met criteria for expert physician review. Secondary efficacy endpoints included changes in sedative and analgesic requirements, and successful extubation.

Results: Seventy-two propofol courses from 58 patients were included. Patients received a median maximum propofol dose of 6 mg/kg/min with a median duration of infusion of 72 hours. There were zero cases of PRIS per expert review and zero documented clinician suspicion of PRIS. During therapy there was a median maximum decrease in the cohorts’ heart rate by 20% and mean arterial pressure (MAP) by 19%. Forty patients (69%) were extubated upon propofol discontinuation, with a successful extubation rate of 95%. Dose reductions of other sedatives were statistically significant without a notable increase in pain or withdrawal utilizing validated assessment tools.

Conclusions: This retrospective study suggests that with appropriate monitoring, propofol can be used safely and effectively for sedation of critically ill children. Larger studies are warranted to further evaluate the use of propofol continuous infusions as an adjunct sedative in the pediatric critically ill population.