Evaluation of a Propofol Dosing Capping Strategy in Patients with Hypertriglyceridemia and Covid-19

ABSTRACT

INTRODUCTION: Propofol can be associated with hypertriglyceridemia (HTG), which may lead clinicians to change to non-preferred sedatives such as benzodiazepines (BZD) to avoid HTG complications. Patients with COVID-19 have been observed to require increased doses and durations of sedatives, which may increase the risk of HTG development. The purpose of this study was to evaluate a dose capping strategy of propofol versus discontinuation on minimizing BZD exposure in ventilated patients. METHOD(S) This retrospective study included patients with COVID-19 and HTG after receiving propofol between March 1, 2020 and April 30, 2021. HTG was defined as serum triglycerides (TG) greater than or equal to 500 mg/dL. The propofol dose cap used in select patients was a reduced maximum dose of 30 to 40 mcg/kg/min. The remainder of patients had propofol discontinued (standard of care). Descriptive statistics were used to evaluate differences in propofol duration, BZD doses, and intensive care unit (ICU) length of stay (LOS) between groups. Incidence of pancreatitis was also evaluated. RESULT(S) Seventy-one patients were included. The propofol dose cap was used in twenty patients. The mean baseline TG were similar in both groups, 256 mg/dL (standard deviation (SD)=125) in the propofol dose cap group compared to 252 mg/dL (SD=104) in the standard group (P=0.9). Propofol was continued four days longer after dose capping, with a median duration of 11.7 vs. 7.4 days, P=0.255. Cumulative intermittent doses of BZDs were higher in the dose cap cohort (average cumulative dose 28mg vs. 20mg, P=0.245), however BZD continuous infusion cumulative doses were lower (1214mg vs. 1377mg, P=0.778). Median ICU LOS was similar between groups (20.4 vs. 20.9 days, P=0.451). No patients in either group developed pancreatitis. CONCLUSION(S) The dose capping strategy allowed for clinicians to continue using propofol for sedation in mechanically ventilated patients with COVID-19 and HTG. This in turn helped minimize BZD exposure with no evidence of HTG associated adverse effects such as pancreatitis. Future investigation in a larger population is warranted to determine the dose cap impact on clinical outcomes, such as incidence of delirium and length of mechanical ventilation.