Kimberly Ackerbauer, BCCCP, PharmD
Boston Medical Center
Boston, Massachusetts
Disclosure information not submitted.
Megan Feeney, BCCCP, PharmD
Boston Medical Center
Boston, Massachusetts
Disclosure information not submitted.
Brittany Block, PharmD
Pharmacy Practice Resident
UMass Memorial Medical Center, United States
Disclosure information not submitted.
Title: Impact of Daily Propofol Tubing Changes on Bloodstream Infections in Ventilated COVID-19 Patients
Introduction:
The Coronavirus 2019 (COVID-19) pandemic exacerbated disruptions in medication supply chains. With unpredictable shipments and limited supplies throughout the pandemic, several institutions adopted creative strategies to preserve sedatives, including propofol. Manufacturers recommend changing propofol tubing every 12 hours to prevent bacterial growth; however, this practice produces significant waste. In the setting of the shortage crisis, Boston Medical Center extended propofol infusion tubing changes by an additional 12 hours to preserve supply. This study aims to examine the safety of this alternative administration practice.
Methods:
This was a single-center retrospective cohort study of adult intensive care unit (ICU) patients with COVID-19 who received propofol for greater than 24 hours. The primary outcome was the incidence of bloodstream infections during the index hospitalization. Secondary outcomes were ICU length of stay and in-hospital all-cause mortality.
Results:
The analysis included 41 patients with a median duration of propofol therapy of 129 hours. Bloodstream infections resulted in four patients (9.8%). Intensive Care Unit length of stay for the study population was a median of 14.9 days and 41.5% of patients died while in the hospital. No significant differences in clinical characteristics or secondary outcomes were seen between those who developed bloodstream infections and those that did not.
Conclusions:
Bloodstream infections in this population were in line with that of the general COVID-19 ICU cohort. Our results do not support routine use of the alternative propofol administration practice, however, risks and benefits should be weighed during a drug shortage crisis.