.jpg "Carley Strzalka, BCPS, PharmD photo")
Carley Strzalka, BCPS, PharmD
Clinical Pharmacist
Inova Fairfax Medical Campus
Falls Church, VA
Disclosure information not submitted.
Jenna Smith, PharmD, BCCCP
Medical-Surgical ICU Clinical Pharmacy Specialist
Inova Fairfax Medical Campus
Falls Church, Virginia, United States
Disclosure information not submitted.
Title: Safety of Propofol for Sedation in Patients with COVID-19 Acute Respiratory Distress Syndrome
Introduction: Patients with acute respiratory distress syndrome (ARDS) require deep sedation and neuromuscular blockade to facilitate ventilator synchrony. It has been observed that patients with COVID-19 ARDS (C-ARDS) often have higher sedation requirements. Propofol is a first line sedative in the ICU. Risk of adverse effects of propofol, including hypertriglyceridemia, are increased at higher doses and longer durations. The purpose of this study was to evaluate the safety of propofol in patients with C-ARDS.
Methods: A retrospective, single-center cohort study of patients with non-C-ARDS and C-ARDS admitted between March 1, 2020 and August 31, 2020 was performed. Patients were identified using the primary diagnosis documented within the electronic medical system. Patients were excluded if they were admitted to the trauma ICU, received veno-arterial extracorporeal membrane oxygenation (VA-ECMO), transferred from another facility, did not have triglyceride levels monitored when receiving propofol, or C-ARDS patients that did not have PCR confirmed SARS-CoV-2 infection. The primary outcome was incidence of hypertriglyceridemia (≥500 mg/dL). For comparison, cumulative dose and time on propofol were collected. Secondary outcomes included incidence of pancreatitis and propofol infusion syndrome (PRIS), maximum triglyceride levels, ICU length of stay, and mortality.
Results: A total of 135 patients were included, 113 with C-ARDS and 22 with non-C-ARDS. Overall, C-ARDS patients experienced a higher rate of hypertriglyceridemia than non-C-ARDS patients, (41 [36.3%] vs 1 [4.5%]; p = 0.002). There was a significant difference in the maximum triglyceride levels between the groups, 429 mg/dL (261-566) in C-ARDS vs 201 mg/dL (130-357) in non-C-ARDS (p=0.016).
A lower cumulative dose of propofol was used in C-ARDS prior to identification of hypertriglyceridemia than in non-C-ARDS (median, 14.7 mg vs 28.2 mg; p=0.117). No significant differences were seen in the incidence of pancreatitis (3.5% vs 0%), incidence of PRIS (0% vs 4.5%), ICU length of stay (21.7 days vs 12 days), and mortality (41.6% vs 40.9%).
Conclusion: In patients receiving continuous propofol infusions for sedation in ARDS, this study found that patients with C-ARDS had a higher rate of hypertriglyceridemia compared to non-C-ARDS.