Propofol Infusion in a Mixed PICU: Prevalence of Propofol-Related Infusion Syndrome in a Retrospective Cohort, 2019–2022

Objectives: To describe usage and complications of propofol as a sedative agent in patients younger than 16 years old admitted to a PICU and to identify evidence of propofol-related infusion syndrome (PRIS). Design: Retrospective analysis of routinely collected data with comparison between patients receiving propofol for less than 48 hours compared with greater than or equal to 48 hours. Setting: Single-center mixed PICU in London, United Kingdom. Patients: All patients admitted to the PICU, from November 2019 to November 2022, younger than 16 years old, in whom an infusion of propofol was administered. Interventions: None. Measurements and Main Results: Propofol infusion was used in 1595 patients, 337 of whom had infusions of greater than or equal to 48 hours with a maximum dose of 5 mg/kg/hr and for a maximum duration of 45 days. The cohort age ranged from 1 day to 16 years and included patients with cardiac diagnoses. Patients were administered propofol for a median 76% of their ventilation time, and 26% of patients who were treated with propofol were also treated with noradrenaline. Physiologic variables, blood gases, laboratory values, and discharge summaries were reviewed, and no patients were clinically suspected of having PRIS. Variables previously reported in PRIS were analyzed across each patient’s admission, and we failed to identify an association between abnormal physiologic values and receipt of a propofol infusion or whether duration of propofol infusion was greater than or equal to 48 hours. Hence, the upper limit of the 95% CI for 0 of 1595 gives a PRIS prevalence in our population up to 0.19%. Conclusions: In our single-center, mixed PICU experience during 2019–2022, we have used propofol infusion in children younger than 16 years old. This practice included neonates and children with cardiac pathology. We failed to identify any episodes of clinically suspected PRIS in 1595 patients, including in the group treated for greater than or equal to 48 hours, which gives an upper limit for PRIS prevalence of ~0.19%.