Ilana Gimelbrand
PGY-2 Pharmacy Resident
North Shore University Hospital
Manalapan, NJ
Disclosure information not submitted.
Cristian Merchan, PharmD, BCCCP
Clinical Pharmacotherapy Specialist
NYU Langone, United States
Disclosure information not submitted.
Prachi Bhatt, BCCCP, BCPS, PharmD
Pharmacist
NYU Langone Health - Brooklyn
Brooklyn, New York, United States
Disclosure information not submitted.
Chanie Wassner, Pharm.D., BCCCP, BCIDP
Clinical Pharmacotherapy Specialist
NYU Langone, United States
Disclosure information not submitted.
Diana Altshuler, BCCCP, BCPS, PharmD
Clinical Pharmacotherapy Specialist
NYU Langone Health, United States
Disclosure information not submitted.
Ola Elnadoury, Pharm.D., BCCCP
Clinical Pharmacotherapy Specialist
NYU Langone, United States
Disclosure information not submitted.
Title: Efficacy and Safety of Propofol Dosing Based on Ideal Body Weight vs Actual Body Weight
Introduction: Various weight-based strategies using actual, ideal, adjusted, and lean body weights have been studied for propofol dosing finding that propofol is better related to lean body weight as opposed to actual body weight (ABW). However, the most commonly used dosing strategy is based on ABW due to its high lipophilicity and large volume of distribution. It is not known whether ideal body weight (IBW)-based dosing would have similar efficacy and safety as ABW-based dosing in all patient populations. This study compares the efficacy and safety of ABW- versus IBW-based dosing of continuous propofol infusion in mechanically ventilated adult patients.
Methods: This is a retrospective, multicenter cohort study of mechanically ventilated adult patients in the intensive care units at a large academic health system. The two cohorts were patients receiving continuous propofol infusion based on ABW from January to December 2019 or IBW from June 2020 to November 2020. The primary efficacy endpoint is time to target sedation score based on the Richmond Agitation and Sedation Scale (RASS). The safety endpoints are based on adverse effects of propofol.
Results: Data from 50 patients were analyzed: 25 in the IBW and 25 in the ABW group. Upon evaluation, the IBW group targeted a deeper initial RASS goal (-2 vs. -1, p=0.004), and there was no difference in median body mass index between groups (27.5 vs. 29.2 kg/m2, p=0.938). Despite the difference between groups, there was no difference in time to target RASS when propofol was dosed based on IBW versus ABW (6 vs. 7 hours, p= 0.714) nor in absolute total dose (1.91 vs 1.94 mcg/min, p=0.883). Patients with initial RASS goal targeting light sedation had no difference in time to goal RASS (6 vs. 7 hours, p= 0.910). Outcomes including descriptive information of propofol, duration of mechanical ventilation, ICU and hospital length of stay, re-intubations and mortality were not statistically significant. Adverse events were similar between groups.
Conclusion: Compared to ABW-based dosing, IBW-based dosing may be an alternative dosing strategy of continuous propofol infusion with similar efficacy and safety profiles. Larger studies with matched cohorts are required to confirm these findings and form a conclusion.