Year: 2024
Type: article
Study design: Observational Study
Abstract: Introduction: While mechanical ventilation can be a life saving measure for critically ill children, extubation of those who have remained on extended duration of ventilation in conjunction with higher exposure to sedatives, remains a challenging process.As extubation failure is associated with numerous negative consequences, optimization of sedation during the peri-extubation period is critical.Recently, short term infusions of propofol have been utilized to facilitate extubation due to its favorable pharmacokinetic properties of rapid induction of anesthesia, sensitive titrations, and fast recovery which allows for careful weaning of sedation after discontinuation of opioids and benzodiazepines.However, because of the absence of standard protocols, bridging practices remain variable in the PICU setting and are based on provider experiences and comfort level.Additionally, there is a lack of guidance as to standard infusion doses and the duration of infusion required before extubation is trialed.This project seeks to evaluate propofol as an effective and safe bridging agent for extubation in mechanically ventilated critically ill children and describe the practice patterns to establish an institutional protocol.Methods: This was an IRB approved, retrospective, singlecenter, observational study of pediatric patients admitted to the NewYork-Presbyterian Hospital Morgan Stanley Children's Hospital intensive care unit from February 2020 to August 2023 who required mechanical ventilation for at least 48 hours and received propofol infusion for at least 4 hours during anticipated extubation.Results: There was a total of 52 patients included in the data analysis.The median age, weight and duration of intubation were 2 (IQR: 0.75 -4) years, 11.7 (IQR: 7.7 -20.7) kilograms and 10 (IQR: 6 -20) days, respectively.The majority of patients were intubated for respiratory infection (42.3%), followed by post non-cardiac surgery (26.9%), non-infectious respiratory failure (15.4%), lack of airway protective mechanisms (9.6%), and post cardiac surgery (5.8%).Five patients (9.6%) patients failed extubation, meaning they were re-intubated within 48 hours of extubation.None of the patients experienced propofol infusion syndrome.The median percent change in heart rate from baseline to lowest point during propofol infusion was 16.6% (IQR 7.6 -25) and change in mean arterial pressure was 15.4% (IQR 7.0 -22.4), with only one patient requiring fluid bolus and the initiation of a vasopressor.The median propofol infusion dose and duration were 100 (IQR: 75 -150) mcg/kg/ min and 13.75 (IQR: 9.75 -20.79) hours respectively.Conclusion: In a small cohort of critically ill children, mechanically ventilated for >48 h, and maintained on propofol infusion for >4 h in our pediatric intensive care unit, a short propofol infusion was found to be a feasible and safe bridge to extubation.
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4401529754