Corey Witenko, PharmD, BCPS, BCCCP
SICU Pharmacist
New York-Presbyterian Hospital/Weill Cornell Medical Center
New York, NY
Disclosure information not submitted.
Audrey Littlefield, PharmD, BCPS, BCCCP
Pharmacy Manager, Perioperative Services and Controlled Substances
New York-Presbyterian Hospital/Weill Cornell Medical Center, United States
Disclosure information not submitted.
Sajjad Abedian, MS
Lead Research Informatics Business Analyst
New York-Presbyterian Hospital/Weill Cornell Medical Center, United States
Disclosure information not submitted.
Anjile An, MPH
Biostatistician
NewYork-Presbyterian Hospital/ Weill Cornell Medical Center, United States
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Philip Barie, MBA, MD, MCCM
Professor of Surgery and Public Health In Medicine
Weill Medical College and Graduate School
New York, New York
Disclosure information not submitted.
.jpg "Karen Berger, PharmD, FCCM photo")
Karen Berger, PharmD, FCCM
Nova Southeastern University
Fort Lauderdale, Florida
Disclosure information not submitted.
Title: Propofol-related infusion syndrome in mechanically ventilated adults with Coronavirus Disease 2019
Introduction: Propofol-related infusion syndrome (PRIS) is a rare and potentially devastating complication associated with prolonged high doses of propofol. There is a lack of diagnostic specificity and clinical presentations are also nonspecific. There is minimal data about PRIS in patients with Coronavirus Disease 2019 (COVID-19). The objective of this study was to evaluate the incidence and characterize the presentations of patients with possible PRIS.
Methods: Retrospective cohort study of adult patients with a positive nasopharyngeal swab for SARS-CoV-2 admitted to an intensive care unit across two hospitals between March 2020 and April 2020. Patients who received propofol for > 12 h were included; those transferred from an outside hospital already supported by mechanical ventilation were excluded. All patients with a creatinine kinase (CK) concentration > 5000 U/L were evaluated for PRIS. PRIS was considered possible if patients had an elevated CK and > 2 of the following within 24 h: anion gap metabolic acidosis (AGMA), serum lactate concentration > 4 mmol/L, serum potassium concentration > 5.5 mEq/L, acute bradyarrhythmia or cardiovascular collapse, acute kidney injury (AKI) defined as increased creatinine > 0.3 mg/dL or 50% baseline, or elevated liver enzymes (3x upper limit of normal). The primary outcome was incidence of possible PRIS. Secondary outcomes included propofol dose and duration upon suspicion of PRIS, characterization of PRIS presentation, and mortality.
Results: Among 252 patients included, eight (3.2%) had possible PRIS. The most common criteria present were elevated liver enzymes (75%), AGMA (88%), and AKI (100%). Two (25%) patients met all of the defined criteria for PRIS. The median propofol dose upon suspicion of possible PRIS was 20 mcg/kg/min (range, 20-50 mcg/kg/min) and providers decreased the dose in six (75%) patients at that time. The duration of propofol administration prior to possible PRIS was 2-17 d. Mortality within 7 d of diagnosis of possible PRIS was 25%.
Conclusions: Although challenging to diagnose, the incidence of possible PRIS was low. However, possible PRIS was identified at lower doses than reported in the literature. Patients with COVID-19 on any propofol infusion rate should be monitored closely and assessed for PRIS.