Propofol Infusion Syndrome: Efficacy of a Prospective Screening Protocol

Area of Science:

• Critical Care Medicine
• Pharmacology
• Toxicology

Background:

• Propofol infusion syndrome (PIS) is a severe, potentially fatal complication associated with propofol use.
• PIS is characterized by rhabdomyolysis, metabolic acidosis, and cardiac dysfunction.
• Early detection and prevention strategies for PIS are crucial in managing critically ill patients.

Purpose of the Study:

• To evaluate the efficacy of a prospective screening protocol designed to prevent Propofol Infusion Syndrome.
• To identify reliable biomarkers for early detection of PIS during continuous propofol infusions.

Main Methods:

• A prospective screening protocol was implemented for trauma patients receiving continuous propofol infusions.
• Serum creatine phosphokinase (CPK) and lactate levels were monitored daily.
• Propofol was discontinued upon meeting positive screening criteria (CPK > 5000 IU/L or lactate > 4 mmol/L).

Main Results:

• The screening protocol successfully prevented all cases of PIS.
• Elevated CPK levels led to propofol discontinuation in 5.3% of patients.
• While the positive screened group had longer ICU stays and increased vent days, mortality rates were similar between groups.

Conclusions:

• The prospective screening protocol, particularly serial CPK monitoring, is effective in preventing Propofol Infusion Syndrome.
• Serum lactate monitoring can be omitted from the screening protocol without compromising PIS prevention.
• This protocol offers a valuable tool for enhancing patient safety during propofol therapy.