Marler Jacob, Howland Rachel, Kimmons Lauren A, Mohrien Kerry, Vandigo Joseph E, Jones G Morgan
Methodist University Hospital, Memphis, TN, USA.
University of Tennessee Health Sciences Center, Memphis, TN, USA.
Hosp Pharm. 2022 Apr;57(2):287-293. doi: 10.1177/00185787211029547. Epub 2021 Jul 8.
Septic patients are at risk for hypotension, and this risk may increase during rapid sequence intubation (RSI). Sedatives such as propofol must be used carefully due to its ability to reduce vascular sympathetic tone. Since the safety of propofol for RSI is not well described in sepsis, this was a study evaluating propofol and its effects on hemodynamics when used for RSI in a septic population.
We conducted a multicenter, retrospective, cohort study of patients with sepsis or severe sepsis requiring sedation for RSI. Patients receiving a propofol bolus for RSI were compared to patients undergoing RSI without a propofol bolus. The safety profile of propofol was evaluated according to the rates of post-intubation hypotension and vasopressor utilization between groups.
A total of 179 patients (79 propofol, 100 non-propofol) were evaluated. There were no differences in hypotension (81% vs 78%; = .62) or vasopressor utilization between the propofol and non-propofol groups (43% vs 49%; = .43). Patients in the non-propofol group had increased APACHE II scores and healthcare-associated infections.
In this cohort study, administration of propofol for RSI in patients with sepsis and severe sepsis did not increase incidence of hypotension or vasopressor use, but acute illness may have introduced provider selection bias causing less propofol use in the non-propofol group. Larger prospective studies are needed to better characterize the adverse hemodynamic effects of propofol, before propofol bolus doses for RSI can be considered for safe use in this population.
脓毒症患者存在低血压风险，且在快速序贯诱导插管（RSI）期间该风险可能增加。由于丙泊酚能够降低血管交感神经张力，因此必须谨慎使用此类镇静剂。鉴于丙泊酚用于脓毒症患者RSI的安全性尚未得到充分描述，本研究旨在评估丙泊酚及其在脓毒症患者RSI时对血流动力学的影响。
我们对因RSI需要镇静的脓毒症或严重脓毒症患者进行了一项多中心、回顾性队列研究。将接受丙泊酚推注用于RSI的患者与未接受丙泊酚推注进行RSI的患者进行比较。根据两组插管后低血压发生率和血管升压药使用情况评估丙泊酚的安全性。
共评估了179例患者（丙泊酚组79例，非丙泊酚组100例）。丙泊酚组和非丙泊酚组在低血压发生率（81%对78%；P = 0.62）或血管升压药使用情况（43%对49%；P = 0.43）方面无差异。非丙泊酚组患者的急性生理与慢性健康状况评分系统（APACHE II）评分和医疗相关感染增加。
在这项队列研究中，脓毒症和严重脓毒症患者RSI时使用丙泊酚并未增加低血压发生率或血管升压药的使用，但急性疾病可能导致了医生选择偏倚，使得非丙泊酚组使用丙泊酚较少。在考虑将丙泊酚推注剂量用于该人群RSI的安全使用之前，需要进行更大规模的前瞻性研究以更好地描述丙泊酚的不良血流动力学效应。
