Vasopressors and propofol infusion syndrome in severe head trauma. Neurocrit Care 2009;10(2):166-72
Date
12/04/2008Pubmed ID
19051063DOI
10.1007/s12028-008-9163-yScopus ID
2-s2.0-66649112334 (requires institutional sign-in at Scopus site) 24 CitationsAbstract
INTRODUCTION: Propofol infusion syndrome (PRIS) is a rare, but lethal complication of high-dose propofol infusions. We undertook this study to evaluate the incidence of PRIS in a cohort of patients with severe head trauma and its relation to the use of vasopressors.
METHODS: We reviewed all patients with severe head trauma admitted to our Neuro-Intensive Care Unit over a 4-year period for use of propofol and vasopressors. Those patients who developed unexplained acidosis, creatine kinase elevation unrelated to trauma, and electrocardiographic changes were considered having PRIS. We investigated the concomitant use of vasopressors while propofol was used and calculated odds ratios for developing PRIS.
RESULTS: We report three adult patients who developed PRIS out of 50 (6%) admitted patients with severe head trauma on propofol infusions. Two of these patients survived and one expired after withdrawal of life support. Concomitant use of vasopressors was associated with development of PRIS in this cohort (odds ratio 29, 95% CI 1.5-581, P < 0.05).
CONCLUSIONS: Awareness and early recognition of PRIS in critically ill neurosurgical patients on vasopressors and daily screening for creatine kinase elevation, unexplained acidosis, or electrocardiographic changes may reduce the incidence and case-fatality.
Author List
Smith H, Sinson G, Varelas PAuthor
Grant P. Sinson MD Associate Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AcidosisAdult
Aged
Aged, 80 and over
Combined Modality Therapy
Craniocerebral Trauma
Creatine Kinase
Drug Therapy, Combination
Electrocardiography
Fatal Outcome
Humans
Hypnotics and Sedatives
Incidence
Infusions, Intravenous
Male
Middle Aged
Propofol
Rhabdomyolysis
Severity of Illness Index
Tachycardia, Ventricular
Vasoconstrictor Agents
Young Adult