Table 12.48 Propofol for the Acute Management of ABI
|
Author Year Country Research Design PEDro Sample Size |
Methods | Outcomes |
|
(2014b) USA Case Series N=117 |
Population: TBI; Mean Age=40.0 yr; Gender: Male=93, Female=24; Median GCS=6. Intervention: Participants were included in retrospective analysis after having received one of the following ICP therapies: hypertonic saline (HTS), mannitol, propofol, fentanyl, and barbiturates. Outcome Measure: Intracranial Pressure (ICP). | 1. Treatment with HTS resulted in the largest ICP decrease of the treatments examined. 2. Propofol and fentanyl escalations resulted in smaller but significant ICP reductions. 3. Mannitol resulted in statistically insignificant reductions in the first hr but rebounded by the second hr. |
|
(2009) USA Case Series N=146 |
Population: TBI; GCS Range≤8. Intervention: Patients who received propofol and/or vasopressors were included in retrospective analysis. Outcome Measures: Propofol Infusion Syndrome (PRIS), Mortality. | 1. Only 3 patients on both propofol and vasopressors developed PRIS. 2. There were no patients on only propofol or vasopressors who developed PRIS. 3. PRIS was not linked to mortality (p>0.05). |
|
(1989) Ireland Case Series N=10 |
Population: TBI; Mean Age=36.8 yr; Gender: Male=9, Female=1; Mean GCS=4.9. Intervention: Patients received an intravenous infusion of 1% propofol (2-4 mg/kg/hr). Measurements were obtained for 24 hr. Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Mean Arterial Pressure (MAP), Heart Rate (HR), Adverse Outcomes. | 1. ICP was significantly reduced at 2 hr (- 2.1 mmHg, p<0.05). 2. CPP was significantly increasedat 24 hr (+9.8 mmHg, p<0.05). 3. No significant differences were seen in MAP or HR. 4. Propofol was not associated with any adverse outcomes. |
| Multimodal Propofol Interventions | ||
|
(2012) USA RCT Crossover PEDro=5 N=8 |
Population: TBI=4, SAH=3, ICH=1; Mean GCS=6.1. Intervention: Patients were randomized to receive sedation with either propofol (25.5 µg/kg/min) or dexmedetomidine (0.54 µg/kg/hr) for 4hr. Crossover occurred after 2 hr. Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP). | 1. No significant differences in ICP or CPP were found between the propofol and dexmedetomidine groups. |
|
(1999) USA RCT PEDro=8 N=42 |
Population: TBI; Propofol (PROP, n=23): Mean Age=39 yr; Gender: Male=18, Female=5; Mean Time Post Injury=34 hr; Median GCS=7. Morphine (MOR, n=19): Mean Age=38 yr; Gender: Male=17, Female=2; Mean Time Post Injury=38 hr; Median GCS=6. Intervention: Patients were randomized to receive sedation with either PROP (20 mg/mL) or MOR (Avg. 10 mg/h). Both groups received additional bolus of MOR (1-3 mg/hr) for at least 48 hr for analgesic purposes. Assessments were made at baseline, days 1, 2, 3, and 4, and at 6 mo. Outcome Measures: Intracranial pressure (ICP), Glasgow Outcome Scale (GOS), Disability Rating Scale (DRS). | 1. On day 3, ICP was significantly lower in PROP compared to MOR (p<0.05). 2. ICP therapy in PROP was also less intensive than MOR. 3. At 6 mo, scores were not significantly different between groups for mortality or favourable outcome rates (GOS>4). 4. In subgroup analysis, PROP was divided into high-dose (100 mg/kg, n=10) and low-dose (<100 mg/kg, n=13) groups. The high-dose group showed higher mean CPP on day 2 (81 mmHg versus 68 mmHg) and lower mean ICP on day 3 (14 mmHg versus 15 mmHg) compared to low-dose (p>0.05). 5. High-dose group demonstrated more favourable outcomes in the GOS (70% versus 38.5%) and the DRS (80% versus 46.2%) compared to the low-dose group (p>0.05). |
|
(1994) UK PCT N=15 |
Population: ABI; Propofol (PROP, n=9): Mean Age=30.5 yr; Gender: Male=8, Female=1; Severity of Injury: Moderate=2, Severe=7; Morphine and Midazolam (M+M, n=6): Mean Age=30.5 yr; Gender: Male=6, Female=0; Severity of Injury: Moderate=1, Severe=5. Intervention: Patients received sedation with either PROP (150-400 mg/hr) or morphine (0-4 mg/hr) with midazolam (0-5 mg/hr). Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Mean Arterial Pressure (MAP), Global Brain Metabolism (AVDO2), Glasgow Outcome Scale (GOS). | 1. PROP led to a decrease in AVDO2 at 4 hr (6.0±2.6 mL/dL to 3.0±0.6 mL/dL, p<0.02). 2. No difference was reported between groups in ICP, CPP, and MAP. 3. No difference was reported between groups in functional outcomes on GOS at 6mo. |