The safety of high dose continuous propofol infusion in the pediatric intensive care unit at an academic medical center

Introduction: Adequate sedation is crucial in the care of critically ill children. Propofol, known for its rapid onset, reliable patient response, and short duration of action, offers an attractive pharmacologic profile. However, concerns for propofol-related infusion syndrome (PRIS) have limited its use in pediatric critical care. This study examined the relationship between propofol administration and PRIS characteristics in a single medical-surgical pediatric intensive care unit (PICU). We hypothesized that continuous propofol infusion, even when judiciously exceeding current recommended doses and durations, is not associated with cardiovascular collapse, metabolic acidosis, or other PRIS-related characteristics. Methods: This is a retrospective single-center study in the non-cardiac medical/surgical PICU at a tertiary academic medical center of 554 patients. Children aged 0-17 years admitted to the PICU from 1/1/2000 to 9/30/2024, who received propofol infusions for ≥12 h and/or ≥2.4 mg/kg/hour (40 mcg/kg/min) were included. The primary outcome was in-hospital mortality; secondary outcomes included intensive care unit (ICU) length of stay, bradycardia during infusion, and metabolic acidosis during infusion. Data was compared across age groups (