Smith Heidi, Sinson Grant, Varelas Panayiotis
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Neurocrit Care. 2009;10(2):166-72. doi: 10.1007/s12028-008-9163-y. Epub 2008 Dec 3.
Propofol infusion syndrome (PRIS) is a rare, but lethal complication of high-dose propofol infusions. We undertook this study to evaluate the incidence of PRIS in a cohort of patients with severe head trauma and its relation to the use of vasopressors.
We reviewed all patients with severe head trauma admitted to our Neuro-Intensive Care Unit over a 4-year period for use of propofol and vasopressors. Those patients who developed unexplained acidosis, creatine kinase elevation unrelated to trauma, and electrocardiographic changes were considered having PRIS. We investigated the concomitant use of vasopressors while propofol was used and calculated odds ratios for developing PRIS.
We report three adult patients who developed PRIS out of 50 (6%) admitted patients with severe head trauma on propofol infusions. Two of these patients survived and one expired after withdrawal of life support. Concomitant use of vasopressors was associated with development of PRIS in this cohort (odds ratio 29, 95% CI 1.5-581, P < 0.05).
Awareness and early recognition of PRIS in critically ill neurosurgical patients on vasopressors and daily screening for creatine kinase elevation, unexplained acidosis, or electrocardiographic changes may reduce the incidence and case-fatality.
丙泊酚输注综合征（PRIS）是高剂量丙泊酚输注罕见但致命的并发症。我们开展这项研究以评估重症颅脑外伤患者队列中PRIS的发生率及其与血管升压药使用的关系。
我们回顾了4年间入住我院神经重症监护病房的所有重症颅脑外伤患者丙泊酚和血管升压药的使用情况。那些出现无法解释的酸中毒、与外伤无关的肌酸激酶升高以及心电图改变的患者被视为患有PRIS。我们调查了使用丙泊酚时血管升压药的联合使用情况，并计算了发生PRIS的比值比。
我们报告了50例接受丙泊酚输注的重症颅脑外伤成年患者中有3例（6%）发生PRIS。其中2例患者存活，另1例在撤除生命支持后死亡。在该队列中，血管升压药的联合使用与PRIS的发生相关（比值比29，95%可信区间1.5 - 581，P < 0.05）。
对使用血管升压药的重症神经外科患者提高对PRIS的认识并早期识别，以及每日筛查肌酸激酶升高、无法解释的酸中毒或心电图改变，可能会降低发病率和病死率。
