Heybati Kiyan, Xie Guozhen, Deng Jiawen, Walkey Allan J, Gajic Ognjen, Yadav Hemang
Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Department of Anesthesiology, University of Michigan, Ann Arbor, MI.
Crit Care Explor. 2025 Sep 5;7(9):e1313. doi: 10.1097/CCE.0000000000001313. eCollection 2025 Sep 1.
Propofol is a first-line sedative for adults receiving invasive mechanical ventilation (IMV). However, it can contribute to hemodynamic instability, especially during intubation. The magnitude, timing, risk factors, and variability of sedation-associated mean arterial pressure (MAP) changes remain poorly characterized in ICU settings.
To quantify MAP changes following propofol sedation, identify risk factors for hemodynamic instability, and characterize associated interventions.
Retrospective cohort study. The primary outcome was MAP change within 2 hours following sedation. Secondary outcomes included vasopressor use and hypotension (MAP ≤ 60 mm Hg). Mixed-effects modeling was used to account for individual patient differences.
Adults (≥ 18 yrs old) who required IMV and received greater than or equal to 6 consecutive hours of propofol infusion, between May 5th, 2018, and July 31st, 2024, in 11 ICUs across the Mayo Clinic, spanning 5 hospitals in 4 states.
The primary outcome was the change in MAP within 2 hours following the initiation of propofol-based sedation.
Across 16,418 patients, 25.2% were on vasopressors before sedation initiation. Among the remaining 12,281 patients, 40.3% required vasopressors and 7.7% experienced hypotension within 2 hours of sedation. Propofol-based sedation was associated with a MAP reduction within the first 30 minutes (-6.58 mm Hg; 95% CI, -6.85 to -6.32; p < 0.001). There was substantial interpatient variability in both baseline MAP, and MAP decline after sedation (9.5 and 40.9% between-patient differences, respectively). Higher Sequential Organ Failure Assessment (SOFA) scores (-0.31 mm Hg/point), older age (-0.04 mm Hg/yr), and male sex (-0.47 mm Hg) were associated with lower MAP. Patients with higher illness severity experienced progressively greater MAP decline over time (-0.20 mm Hg/hr/SOFA point; p < 0.001).
Propofol-based sedation was associated with clinically significant hemodynamic effects requiring intervention in the early post-intubation period. The marked interpatient variability in hemodynamic responses highlights the importance of personalized management approaches, including risk stratification based on age, sex, and illness severity.
丙泊酚是接受有创机械通气（IMV）的成人的一线镇静剂。然而，它可能导致血流动力学不稳定，尤其是在插管期间。在重症监护病房（ICU）环境中，与镇静相关的平均动脉压（MAP）变化的幅度、时间、危险因素和变异性仍未得到充分描述。
量化丙泊酚镇静后的MAP变化，确定血流动力学不稳定的危险因素，并描述相关干预措施。
回顾性队列研究。主要结局是镇静后2小时内的MAP变化。次要结局包括血管升压药的使用和低血压（MAP≤60mmHg）。采用混合效应模型来考虑个体患者差异。
2018年5月5日至2024年7月31日期间，在梅奥诊所的11个ICU中，来自4个州5家医院的需要IMV并接受连续6小时及以上丙泊酚输注的成人（≥18岁）。
主要结局是基于丙泊酚的镇静开始后2小时内的MAP变化。
在16418例患者中，25.2%在镇静开始前使用血管升压药。在其余12281例患者中，40.3%在镇静后2小时内需要使用血管升压药，7.7%出现低血压。基于丙泊酚的镇静与最初30分钟内MAP降低相关（-6.58mmHg；95%CI，-6.85至-6.32；p<0.001）。患者的基线MAP和镇静后MAP下降均存在显著的个体间差异（分别为9.5%和40.9%的患者间差异）。较高的序贯器官衰竭评估（SOFA）评分（-0.31mmHg/分）、年龄较大（-0.04mmHg/年）和男性（-0.47mmHg）与较低的MAP相关。疾病严重程度较高的患者随着时间的推移MAP下降逐渐更大（-0.20mmHg/小时/SOFA分；p<0.001）。
基于丙泊酚的镇静与插管后早期需要干预的具有临床意义的血流动力学效应相关。血流动力学反应中显著的个体间差异凸显了个性化管理方法的重要性，包括基于年龄、性别和疾病严重程度的风险分层。
