Predictors of severe hypotension in neurocritical care patients sedated with propofol

G. Morgan Jones, Bruce A. Doepker, Michael J. Erdman, Lauren A. Kimmons, Lucas Elijovich

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Introduction: Propofol is used extensively in neurocritical care (NCC) due to its pharmacologic properties allowing for facilitation of serial neurologic examinations. Despite widespread use, few studies have identified risk factors for hypotension in these patients. We aimed to determine predictors of hypotension in NCC patients sedated with propofol. Methods: This retrospective, multicenter study evaluated 237 patients at two academic medical centers, both with dedicated NCC teams led by board-certified neurointensivists. Univariate analyses were performed to determine risk factors associated with severe hypotension during sedation with propofol. Multivariable analysis was performed to determine variables independently associated with hypotension, defined as a mean arterial pressure (MAP) less than 60 mmHg. Results: There was an average maximum reduction in MAP of 28.8 % after propofol initiation in the entire cohort. Severe hypotension developed in 62 (26.2 %) patients to a median nadir MAP of 56 mmHg. Those who developed severe hypotension had a longer median duration of mechanical ventilation (5.0 vs. 3.6 days; p = 0.01) and an increased in-hospital mortality (38.7 vs. 24.0 %; p = 0.03). Multivariable logistic regression analysis identified increasing number of changes to the propofol infusion rate, baseline MAP 60-70 mmHg, and need for renal replacement therapy (RRT) as factors independently associated with hypotension. Conclusions: Multiple factors predicted hypotension in NCC patients receiving propofol. Clinicians should use propofol cautiously in patients with a lower baseline MAP or receiving RRT. Development of protocols related to the frequency of dose titrations is also recommended to prevent this avoidable complication.

Original languageEnglish (US)
Pages (from-to)270-276
Number of pages7
JournalNeurocritical Care
Volume20
Issue number2
DOIs
StatePublished - Jan 1 2014

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Propofol
Hypotension
Patient Care
Arterial Pressure
Renal Replacement Therapy
Neurologic Examination
Hospital Mortality
Artificial Respiration
Multicenter Studies
Retrospective Studies
Logistic Models
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Predictors of severe hypotension in neurocritical care patients sedated with propofol. / Jones, G. Morgan; Doepker, Bruce A.; Erdman, Michael J.; Kimmons, Lauren A.; Elijovich, Lucas.

In: Neurocritical Care, Vol. 20, No. 2, 01.01.2014, p. 270-276.

Research output: Contribution to journalArticle

Jones, G. Morgan ; Doepker, Bruce A. ; Erdman, Michael J. ; Kimmons, Lauren A. ; Elijovich, Lucas. / Predictors of severe hypotension in neurocritical care patients sedated with propofol. In: Neurocritical Care. 2014 ; Vol. 20, No. 2. pp. 270-276.
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