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Propofol as a bridge to extubation in the pediatric intensive care unit

Mack, Elizabeth H.

Abstract Details

2009, MS, University of Cincinnati, Medicine : Environmental Health.

Objective: A significant number of children require long-term sedation and mechanical ventilation, which leads to significant morbidity and mortality. Propofol use decreases time to extubation and extubation failure in adults. However, there are safety concerns with long-term use of propofol, particularly in children. The purpose of this study is to report the safety and efficacy of propofol used as a bridge to extubation in children who have received long-term mechanical ventilation and sedation.

Methods: After querying the pharmacy database, charts were reviewed to screen for propofol infusion use in pediatric and cardiac intensive care units at a single large children's hospital. A total of 152 uses of propofol (representing 141 unique patients) were analyzed in this case series. We measured exposure to propofol by total dose, average dose, maximum dose, and duration of propofol use. We assessed safety of propofol use in this limited setting by evaluating the incidence of bradycardia, hypotension, acidosis, and mortality. Efficacy is measured by time to extubation and extubation success.

Results: Median time to extubation was 30 minutes and the extubation failure rate was 20%. Bradycardia (42%) and hypotension (28%) are common, but typically self-limited. Inotrope requirement prior to initiation of propofol predicted hypotension and acidosis. There were no cases of propofol infusion syndrome.

Conclusions: The short-term use of propofol as a bridge to extubation in pediatric patients after longterm ventilation is a safe and effective strategy if used in carefully selected hemodynamically stable patients.

Kim Dietrich, Ph.D. (Committee Chair)
M.B. Rao, Ph.D. (Committee Member)
Derek Wheeler, M.D. (Committee Member)
Lesley Doughty, M.D. (Committee Member)
17 p.

Recommended Citations

Citations

  • Mack, E. H. (2009). Propofol as a bridge to extubation in the pediatric intensive care unit [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1243354898

    APA Style (7th edition)

  • Mack, Elizabeth. Propofol as a bridge to extubation in the pediatric intensive care unit. 2009. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1243354898.

    MLA Style (8th edition)

  • Mack, Elizabeth. "Propofol as a bridge to extubation in the pediatric intensive care unit." Master's thesis, University of Cincinnati, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1243354898

    Chicago Manual of Style (17th edition)