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Updated: Oct 17, 2026
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Continuous propofol infusion for severe pediatric traumatic brain injury: A single-institution retrospective
Kumaran Senthil1, Vanessa M Mazandi1, Daniel Balcarcel1
1Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, Philadelphia, PA, USA.
Objective:
Propofol sedation following severe traumatic brain injury (TBI) may facilitate neurologic assessments and treat elevated intracranial pressure (ICP). While 2019 Brain Trauma Foundation pediatric guidelines discourage prolonged propofol use due to propofol-related infusion syndrome (PRIS), 2022 PANDEM guidelines support infusions < 67 mcg/kg/minute for ≤ 48 h. We describe use of propofol sedation following severe pediatric TBI in our quaternary pediatric center.
Methods:
We analyzed pediatric patients who received ≥ 12 h of propofol infusion with severe TBI (GCS ≤8) from 2019 to 2025.
Results:
Twenty-one pediatric patients with severe TBI received propofol for ≥ 12 h. Median duration was 23.5 h (IQR 16.5-38.7, maximum 137.5), median infusion rate was 62.6 mcg/kg/min (IQR 47.2-89.8, maximum 124) and median total dose was 101.6 mg/kg (IQR 58.3-152.8, maximum 345.3). Of nine patients with ICP monitoring, six had complete data sets; vasoactive-inotropic scoring (VIS) was higher while on propofol, but without deleterious effect on ICP or cerebral perfusion pressure (CPP). Propofol was not stopped in any patients due to clinical or laboratory signs of PRIS. All patients with follow-up had a favorable 6-month GOS-E.
Conclusion:
We describe 21 pediatric patients who received propofol sedation following severe TBI. No patients had clinical concerns for PRIS; of patients with invasive neuromonitoring, no deleterious effects on ICP and CPP were observed. Among patients with follow-up, all survived with favorable neurologic outcome. In certain pediatric patients, propofol may be an appropriate sedative option following severe TBI.
