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Incidence of propofol-related infusion syndrome in critically ill adults: a prospective, multicenter study

机译：危重成年人丙泊酚相关输注综合征的发生率：一项前瞻性，多中心研究

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IntroductionWhile propofol is associated with an infusion syndrome (PRIS) that may cause death, the incidence of PRIS is unknown. Determining the incidence of PRIS and the frequency of PRIS-related clinical manifestations are key steps prior to the completion of any controlled studies investigating PRIS. This prospective, multicenter study sought to determine the incidence of PRIS and PRIS-related clinical manifestations in a large cohort of critically ill adults prescribed propofol.MethodsCritically ill adults from 11 academic medical centers administered an infusion of propofol for [>/=] 24 hours were monitored at baseline and then on a daily basis until propofol was discontinued for the presence of 11 different PRIS-associated clinical manifestations and risk factors derived from 83 published case reports of PRIS.ResultsAmong 1017 patients [medical (35%), neurosurgical (25%)], PRIS (defined as metabolic acidosis plus cardiac dysfunction and [>/=] 1 of: rhabdomyolysis, hypertriglyceridemia or renal failure occurring after the start of propofol therapy) developed in 11 (1.1%) patients an average of 3 (1-6) [median (range)] days after the start of propofol. While most (91%) of the patients who developed PRIS were receiving a vasopressor (80% initiated after the start of propofol therapy), few received a propofol dose >83 mcg/kg/min (18%) or died (18%). Compared to the 1006 patients who did not develop PRIS, the APACHE II score (25 +/- 6 vs 20 +/- 7, P = 0.01) was greater in patients with PRIS but both the duration of propofol use (P = 0.43) and ICU length of stay (P = 0.82) were similar.ConclusionsDespite using a conservative definition for PRIS, and only considering new-onset PRIS clinical manifestations, the incidence of PRIS slightly exceeds 1%. Future controlled studies focusing on evaluating whether propofol manifests the derangements of critical illness more frequently than other sedatives will need to be large. These studies should also investigate the mechanism(s) and risk factors for PRIS.
机译：简介虽然异丙酚与可能导致死亡的输液综合症（PRIS）相关，但PRIS的发生率尚不清楚。在完成任何调查PRIS的对照研究之前，确定PRIS的发生率和PRIS相关临床表现的频率是关键步骤。这项前瞻性，多中心研究旨在确定在大量处方丙泊酚的危重成年人中PRIS和PRIS相关临床表现的发生率。方法来自11个学术医学中心的危重成年人在24小时内输注了丙泊酚[> / =]在基线时进行监测，然后每天进行监测，直至因11种不同的PRIS相关临床表现和源自83篇发表的PRIS病例报告的危险因素而停用丙泊酚。结果1017例患者[医学（35％），神经外科（25％） ％）]，PRIS（定义为代谢性酸中毒加心脏功能障碍，并且[> / =] 1：在开始丙泊酚治疗后发生横纹肌溶解，高甘油三酯血症或肾功能衰竭的患者）在11（1.1％）位患者中平均3（1 -6）[异丙酚开始服用后的[中位数（范围）]天。虽然大多数（91％）发生PRIS的患者正在接受血管加压药（80％在开始丙泊酚治疗后开始使用），但很少接受丙泊酚剂量> 83 mcg / kg / min（18％）或死亡（18％） 。与1006例未发生PRIS的患者相比，PRIS患者的APACHE II评分（25 +/- 6 vs 20 +/- 7，P = 0.01）更高，但是丙泊酚的使用时间（P = 0.43）结论尽管对PRIS采取了保守的定义，并且仅考虑新发的PRIS临床表现，但PRIS的发生率略高于1％。未来的对照研究应侧重于评估异丙酚是否比其他镇静剂更频繁地显示出严重疾病的紊乱。这些研究还应研究PRIS的机制和危险因素。

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