What does this research mean for the field?

In mechanically ventilated pediatric ICU patients, continuous propofol sedation is not associated with increased ventilator-free days after adjusting for illness severity, though it is associated with lower mortality. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This research aims to compare the effects of propofol versus no propofol on ventilator-free days and mortality in pediatric ICU patients requiring mechanical ventilation.

March 26, 2026

1350: Characterization of Propofol Use in a Pediatric Icu

Key Points

This research aims to compare the effects of propofol versus no propofol on ventilator-free days and mortality in pediatric ICU patients requiring mechanical ventilation.
Analyzed electronic health records of pediatric ICU patients needing mechanical ventilation from June 2018 to December 2022.
Compared demographics and clinical variables between patients receiving propofol and those who did not.
Utilized multivariable modeling to assess associations between propofol use and outcomes, adjusting for illness severity markers.
Out of 1,048 patient admissions, 483 received propofol and 565 did not.
There was no significant difference in ventilator-free days between the two groups after adjusting for illness severity (p=0.6).
The propofol group experienced lower mortality rates (10%) compared to the 17.5% in the propofol-free group (p=0.0006).

Abstract

Introduction: SCCM 2022 guidelines recommend propofol as an adjunct sedative for pediatric ICU (PICU) patients due to associations with earlier extubation. However, prior warnings against use in children likely influence practice variability. We aimed to compare outcomes in PICU patients requiring mechanical ventilation with and without propofol for continuous sedation. We hypothesized that patients receiving propofol will have more ventilator-free days (VFDs) than those who do not. Methods: We queried EHR from a single tertiary center for PICU patients requiring invasive mechanical ventilation from June 2018 to December 2022. We compared demographics, admission diagnoses, and clinical variables between patients who did and did not receive propofol. Surrogate markers of illness severity included Pediatric Index of Mortality score (PIM3), continuous renal replacement therapy, extracorporeal membrane oxygenation, vasoactive infusions, and continuous neuromuscular blockade. Markers with significant differences on univariate comparison were retained in the final model. Multivariable modelling investigated associations of propofol with VFDs and mortality, adjusting for admission diagnosis and retained markers of illness. Results: Of 1,048 unique patient admissions analyzed: 483 (46%) received propofol and 565 (54%) did not. Patients receiving propofol were older than those who did not (94 months 23, 177 vs. 26 months 4, 136, p< 0.0001). Patients receiving propofol were less likely to be intubated for respiratory failure, cardiac arrest, or septic shock (p< 0.01) and more likely to be intubated for trauma and traumatic brain injury (p< 0.01). Those receiving propofol had 23 VFDs 13.2, 26.7 with 10% mortality, compared to 23.3 VFDs 14.3, 26.5 with 17.5% mortality in the propofol-free group. After adjusting for admission diagnoses and markers of illness severity, there was no difference in VFDs between groups (p=0.6), but the propofol group had lower mortality (p=0.0006). Conclusions: There was no difference in VFDs between those who did or did not receive propofol after adjusting for underlying illness. A difference in mortality suggests that illness severity may be a possible confounder for the potential benefit of earlier extubation with propofol.

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Cite This Study

Roybal et al. (Sun,) studied this question.

synapsesocial.com/papers/69c4cdcdfdc3bde44891a82a https://doi.org/https://doi.org/10.1097/01.ccm.0001187396.36439.d5

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