In this episode, I’ll discuss the prediction of hypotension from propofol when used as an ICU sedative.
Hypotension from ICU sedatives like propofol and dexmedetomidine can complicate patient management. I discussed predicting hypotension from dexmedetomidine back in Episode 853.
Hypotension from propofol in the ICU can also be reasonably predicted by several factors.
The first is IVC collapsibility. This is assessed by bedside ultrasound, where the inferior vena cava is examined for the percentage of collapse on inspiration. Patients with an IVC collapsibility of more than 43%, as assessed by bedside ultrasonography, are more likely to develop significant hypotension after induction with propofol. This test has a positive predictive value of 94%. This data is from a study that was performed on OR patients; however, it is not specifically from those in the ICU. In general, IVC collapsibility values >50% suggest hypovolemia, so from this study, it may be inferred that hypovolemia is a risk factor for hypotension from propofol.
Whether bedside ultrasound is performed in your ICU is likely provider-dependent. This tool is growing in popularity, and in my experience, newer physicians are more inclined and more comfortable with bedside ultrasound as a diagnostic procedure.
If your providers aren’t doing bedside ultrasound, you aren’t completely out of luck, as at least two studies found other factors that can predict hypotension from propofol:
A study of 200 trauma patients analyzed risk factors for hypotension from propofol and found three that predicted hypotension:
- Age greater than 55 years (Odds Ratio 3.6)
- Obesity (OR 2.7)
- Lower baseline blood pressure (OR 1.6 per 10-mm Hg decrease)
It should be noted that the context of this study was hypotension from using propofol as induction for intubation, not continuous sedation.
Finally, a retrospective study of 237 neurocritical patients examined predictors of hypotension from propofol sedation. Low baseline MAP and need for renal replacement therapy were identified as risk factors for hypotension from propofol.
The topic in this episode is inspired by an in-depth training available to members of my Hospital Pharmacy Academy. The Hospital Pharmacy Academy is my online membership site that will teach you practical critical care and hospital pharmacy skills you can apply at the bedside so that you can become confident in your ability to save lives and improve patient outcomes. To get immediate access to this and many other resources to help in your practice, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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