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Propofol-related infusion syndrome in critically ill pediatric patients: coincidence, association, or causation?

Erin M Timpe1, Samantha F Eichner, Stephanie J Phelps

  • 1Department of Pharmacy Practice, Southern Illinois University Edwardsville, Edwardsville, Illinois.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|November 3, 2012
PubMed

Insights

Propofol-related infusion syndrome (PRIS) can cause severe metabolic acidosis and hemodynamic instability in critically ill patients. This review examines PRIS presentation, mechanisms, and management strategies.

Area of Science:

  • Critical Care Medicine
  • Pharmacology
  • Pediatric Intensive Care

Background:

  • Continuous propofol infusion is widely used for sedation and anesthesia in critically ill patients.
  • Propofol-related infusion syndrome (PRIS) has been increasingly reported in both adult and pediatric populations.
  • PRIS is associated with severe metabolic acidosis, hemodynamic instability, and arrhythmias.

Purpose of the Study:

  • To review the existing literature on propofol-related infusion syndrome (PRIS).
  • To describe the clinical presentation, proposed mechanisms, and potential management of PRIS.
  • To address the ongoing debate regarding propofol's role in PRIS development.

Main Methods:

  • Comprehensive literature search for studies reporting on PRIS.
  • Analysis of clinical characteristics, patient demographics, and outcomes.
  • Review of proposed pathophysiological mechanisms and treatment strategies.

Main Results:

  • PRIS is characterized by metabolic acidosis, hemodynamic instability, and bradyarrhythmias, often refractory to treatment.
  • The syndrome can occur with or without hepatomegaly, rhabdomyolysis, or lipemia.
  • At least 20 deaths in pediatric patients have been attributed to PRIS.

Conclusions:

  • PRIS is a serious complication of continuous propofol infusion in critically ill patients.
  • Understanding the clinical features and mechanisms is crucial for timely diagnosis and management.
  • Further research is needed to elucidate the exact relationship between propofol and PRIS and to develop effective preventative strategies.

Keywords:
adverse effectlipemiametabolic acidosispediatric intensive carepropofol infusion syndromesedation

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