Charlene Kalani, BCCCP, PharmD
Critical Care Clinical Pharmacist
n/a
Houston, Texas
Disclosure information not submitted.
Chelsea Krueger, BCCCP, PharmD
Assistant Professor
Texas Tech School of Pharmacy, United States
Disclosure information not submitted.
Title: Hemodynamic Evaluation of Propofol in Critical Care Adults with Reduced Ejection Fraction
Introduction: As a nonbenzodiazepine agent, propofol is one of the standards of care for sedation in mechanically ventilated patients. The 2016 American Heart Association released a statement classifying propofol as a drug that can cause or exacerbate heart failure due to its negative inotropic and vasodilatory properties. There is limited data of the increased risk of worsening hypotension with propofol specifically in patients with heart failure compared to the those with normal heart function. Therefore, the purpose of this study was to compare the hemodynamic effect of propofol in patients with and without reduced ejection fraction heart failure (HFrEF).
Methods: A retrospective chart review was conducted on mechanically ventilated patients that received propofol continuous infusion at a 775-bed tertiary care institution in the cardiac, medical, thoracic, and general surgical intensive care units. The primary outcome compared the rate of significant hypotension defined as a MAP of 65 mmHg or less in patients with ejection fraction of 40% or less compared to those with normal ejection fraction.
Results: There were 70 patients included in each arm of the study. No difference was found in the incidence of significant hypotension in HFrEF compared to normal ejection fraction patients (40.0% vs. 31.4%, p = 0.29). The degree of hypotension was not found to be significantly different between groups (MAP 62.7 mmHg vs. 64.9 mmHg, p = 0.31). Patients with HFrEF had a higher incidence of significant hypotension within two hours after a 10% propofol increase (OR = 3.42, p = 0.02). The need for new RRT was similar between groups (7.1% vs. 2.9, p = 0.32). Multivariable logistic regression modeling found SOFA score independently associated with increased risk of developing significant hypotension (OR = 1.13 [95% CI 1.01-1.26], p = 0.027).
Conclusions: Patients with HFrEF were not found to be at increased risk for developing significant hypotension during propofol infusion compared to patients without reduced ejection fraction. There may be an increased risk of hypotension in HFrEF patients with dosage increases >10%. Future research with larger sample sizes is needed to assess the hemodynamic consequences of propofol in patients with HFrEF.