USE AND SAFETY OF PROLONGED PROPOFOL INFUSION IN THE PAEDIATRIC INTENSIVE CARE UNIT – A SINGLE CENTRE EXPERIENCE

Propofol is one of the most commonly used hypnotic agents in anaesthesia. Its use in the paediatric critical care units (PICUs) is still controversial, due to the risk of haemodynamic instability and, most of all, propofol related infusion syndrome (PRIS). There is limited safety data with minimal evidence in younger children. AIM This study aims to describe propofol use as continuous infusion in a tertiary care PICU, and to delineate its safety profile and adverse effects. METHODS Retrospective single centre study, including patients < 18 years old admitted to Evelina London Children's Hospital between November 2019 and November 2022 who received propofol as continuous infusion. Data collected included demographics, daily propofol infusion dosage and duration, clinical findings, deaths. PRIS signs and blood pressures were analysed for every hour of the admission while on and off propofol infusions. Discharge summaries were reviewed for adverse effects. RESULTS 1641 patients were included, 904 were males (55%) and median (IQR) age was 3.2 years (0.98-9.29). The most common causes of admission were cardiac diagnosis (583 patients, 35%), respiratory (315 patients, 19%), neurological (147 patients, 9%). PICU mortality was 1.4% and the median (IQR) length of stay was 3.1 days (1.7-6.6). The median (IQR) duration of propofol infusion was 17 (4-46) hours, with the longest infusion of 133 days. The median rate was 3 (2-4) mg/kg/h and the maximum infusion dose was 5 mg/kg/h. None of the 1641 discharge summaries reported PRIS signs or symptoms. Patients off propofol were found to be more often acidotic (0.52 vs 0.48, p<0.01), hyperkalaemic (0.007 vs 0.009, p 0.03), with deranged renal (ratio 0.07 vs 0.05, p value <0.01) and liver function (0.12 vs 0.10 p 0.03). Patients on propofol spiked temperature more frequently than when off propofol (0.45 vs 0.4, p<0.01) and lower blood pressures (p<0.01), but the inotrope requirement did not significantly change whilst on or off propofol (p=0.36). CONCLUSION This is the largest study looking at propofol infusion within PICU and there was no evidence of haemodynamic instability or organ dysfunction. No cases of PRIS or death related to propofol infusion were identified.