(1277) Effect of Maximum Propofol Infusion Rate on Propofol-Related Infusion Syndrome-Related Elements

Introduction: Propofol is a general anesthetic and sedative with uses including the sedation of mechanically ventilated patients. Propofol-related infusion syndrome (PRIS) is a rare yet potentially fatal complication of propofol administration that is not well defined or understood. Identified risk factors include high infusion rates and prolonged infusion durations.

Methods: A multi-center retrospective review was conducted on patients who received a propofol infusion for at least 24 hours before and after the default orderable maximum infusion rate of propofol was changed from 100 mcg/kg/min to 50 mcg/kg/min. The timeframe of records was September 2019 - February 2020 for the pre-change group and September 2022 - February 2023 for the post-change group. The difference in the incidence of five “PRIS-related elements” between the two groups was evaluated: acidosis, acute kidney injury, dysrhythmia, hypertriglyceridemia, and rhabdomyolysis. Secondary outcomes included frequency of propofol infusion rates >50 mcg/kg/min and intensive care unit length of stay.

Results: After exclusion criteria were applied, there were 404 subjects in the pre-change group and 447 in the post-change group. Baseline demographics were similar. No difference was found in primary and secondary outcomes. Logistic regression revealed an association between acidosis and the factors of “pre” group assignment and acute kidney injury.

Conclusions: Although no statistically significant difference was found in the frequency of any outcome measure, it is possible that subjects in the “post” group benefited from the intervention as evidenced by the “pre” group assignment being identified as a risk factor for acidosis. Further investigations could produce more definitive results with a prospective design, collecting outcomes data for all subjects, investigating other risk factors, stratifying results by illness severity, and analyzing either duration of high infusion rates or cumulative propofol doses.