Department of Internal Medicine.
Division of Critical Care Medicine, and.
Ann Am Thorac Soc. 2023 Jan;20(1):94-101. doi: 10.1513/AnnalsATS.202205-403OC.
Propofol is a first-line sedative agent in the intensive care unit (ICU) but may be associated with hypertriglyceridemia and pancreatitis. To date, the relationship between propofol-induced hypertriglyceridemia and pancreatitis, as well as clinician responses to propofol-induced hypertriglyceridemia, have not been comprehensively studied. To assess the incidence of hypertriglyceridemia and pancreatitis in patients receiving continuous propofol infusions in the ICU and to describe the association between hypertriglyceridemia and the use of nonpropofol continuous sedative infusions. This was a retrospective observational cohort study conducted at three urban academic hospitals within a single health system. Findings were additionally validated using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database containing data from a separate tertiary care hospital. Mechanically ventilated adult patients who received a continuous propofol infusion between 2016 and 2021 were included. The primary exposure was serum triglyceride concentration, and hypertriglyceridemia was defined as a triglyceride concentration greater than 400 mg/dl. Outcomes included new-onset pancreatitis as well as receipt of midazolam, dexmedetomidine, or ketamine after the triglyceride measurement. The incidence of pancreatitis was compared between groups using a Fisher's Exact test. Multivariable logistic regression was used to assess the association between dichotomized triglyceride concentration and alternative sedative use. In the primary cohort of 7,037 patients, 1,724 (24.5%) had one or more triglyceride concentration measured. Of these, 1,365 (79.2%) had a maximum concentration of less than 400 mg/dl, and 359 (20.8%) had a maximum concentration of greater than 400 mg/dl. Compared with patients with low triglyceride concentrations, patients with high triglyceride concentrations were more likely to receive a continuous infusion of midazolam (37.0% vs. 16.4%; adjusted odds ratio [aOR], 3.1; 95% confidence interval [CI], 2.2-4.4; < 0.01), ketamine (22.8% vs. 6.9%; aOR, 3.5; 95% CI, 2.3-5.3; < 0.01), and dexmedetomidine (57.7% vs. 46.6%; aOR, 1.5; 95% CI, 1.1-2.0; < 0.01). Rates of midazolam infusion increased as triglyceride concentrations exceeded 500 mg/dl. Forty-four (0.6%) patients developed pancreatitis after propofol initiation, of which 4 (9.1%) were considered related to propofol-associated hypertriglyceridemia. Findings were similar in the MIMIC-IV cohort. Propofol-associated hypertriglyceridemia is relatively common in mechanically ventilated ICU patients who have triglycerides measured. Pancreatitis related to propofol-associated hypertriglyceridemia is rare. Patients who develop hypertriglyceridemia while receiving propofol are more likely to receive continuous infusions of other sedatives.
丙泊酚是重症监护病房（ICU）中的一线镇静剂，但可能与高甘油三酯血症和胰腺炎有关。迄今为止，丙泊酚引起的高甘油三酯血症和胰腺炎之间的关系，以及临床医生对丙泊酚引起的高甘油三酯血症的反应，尚未得到全面研究。本研究旨在评估 ICU 中接受持续丙泊酚输注的患者发生高甘油三酯血症和胰腺炎的发生率，并描述高甘油三酯血症与使用非丙泊酚持续镇静输注之间的关系。这是一项在一个单一医疗系统内的三家城市学术医院进行的回顾性观察队列研究。研究结果还使用了包含来自另一家三级保健医院数据的医疗信息集市用于重症监护-IV（MIMIC-IV）数据库进行了验证。纳入 2016 年至 2021 年期间接受连续丙泊酚输注的机械通气成年患者。主要暴露因素为血清甘油三酯浓度，高甘油三酯血症定义为甘油三酯浓度大于 400mg/dl。结果包括新发生的胰腺炎以及在测量甘油三酯后接受咪达唑仑、右美托咪定或氯胺酮。使用 Fisher 精确检验比较各组之间胰腺炎的发生率。使用多变量逻辑回归评估二分类甘油三酯浓度与替代镇静剂使用之间的关联。在 7037 名患者的主要队列中，有 1724 名（24.5%）患者进行了一次或多次甘油三酯浓度测量。其中，1365 名（79.2%）患者的最大浓度低于 400mg/dl，359 名（20.8%）患者的最大浓度大于 400mg/dl。与甘油三酯浓度较低的患者相比，甘油三酯浓度较高的患者更有可能接受咪达唑仑持续输注（37.0% vs. 16.4%；调整后的优势比[aOR]，3.1；95%置信区间[CI]，2.2-4.4； < 0.01）、氯胺酮（22.8% vs. 6.9%；aOR，3.5；95%CI，2.3-5.3； < 0.01）和右美托咪定（57.7% vs. 46.6%；aOR，1.5；95%CI，1.1-2.0； < 0.01）。随着甘油三酯浓度超过 500mg/dl，咪达唑仑输注的比例增加。在开始使用丙泊酚后，有 44 名（0.6%）患者发生胰腺炎，其中 4 名（9.1%）被认为与丙泊酚相关的高甘油三酯血症有关。在 MIMIC-IV 队列中也发现了类似的结果。在接受机械通气的 ICU 患者中，丙泊酚相关的高甘油三酯血症相对常见，且与丙泊酚相关的高甘油三酯血症相关的胰腺炎很少见。在接受丙泊酚治疗期间发生高甘油三酯血症的患者更有可能接受其他镇静剂的持续输注。
