Propofol infusion syndrome, case series

Abstract

INTRODUCTION: Propofol Infusion Syndrome (PIS) is caused by the parenteral infusion of this drug at high doses (≥ 4 mg/kg/h) for more than 48 hours in the sedation and analgesia of critical patients, which can lead to multiorgan failure and a high risk of mortality.
CLINICAL CASES: Six clinical cases were analyzed in the ICU of the Carlos Andrade Marín Specialties Hospital (HECAM) that met diagnostic criteria, and the follow-up of the patients allowed the identification of multiorgan failure.
RESULTS: In all six cases, the common denominator was hypotension, metabolic acidosis, electrolyte disturbances, increased lactate, and creatine phosphokinase; the final outcome showed that a patient who had Propofol withdrawn temporarily improved his clinical condition, while the rest died by maintaining their infusion.
DISCUSSION: As shown in the study, high diagnostic suspicion can make a difference in reducing multiorgan failure and patient death. The pandemic highlighted the fragility of manufacturing, logistics, and drug procurement chains, putting their availability at risk. Moreover, it is crucial to note that continuous and institutionalized pharmacovigilance can prevent the fatal outcomes of adverse drug reactions.
CONCLUSION: PIS is a rare but deadly event that can occur after prolonged use and high doses of the drug, even sometimes at usual doses. Timely diagnosis allows its immediate withdrawal and improves the prognosis of patients; pharmacovigilance is a fundamental tool to enhance patient safety.