Propofol-related infusion syndrome
Darlene Deters MSN, RN, ARNP, CCRN
Mark Metzler BSN, RN, CCRN, USAF
Maria Morgan BSN, RN, CCRN
Elizabeth Pronovost RN
Laura Feider PhD, RN

Nursing2014 Critical Care
May 2014 
Volume 9  Number 3
Pages 38 - 41
  PDF Version Available!

Mr. G, a 35-year-old White male with a history of seizure disorder (epilepsy), schizophrenia, extensive illicit drug use, and questionable adherence to prescription medications, was brought via emergency medical services to the local Level I trauma center for treatment following a series of unclear events that may have resulted in some manner of trauma. Although early reports suggested involvement in a motor vehicle crash, initial assessment showed no evidence of trauma, although he was reported to be combative in the trauma bay. Mr. G's Glasgow Coma Scale score upon admission was 14 (eye opening: 4, motor response: 6, verbal response: 4). He was subsequently admitted to the trauma service team, who, during their workup, didn't find any evidence of an acute intracranial process or acute injury. During the course of his initial medical management, Mr. G developed sustained seizure activity. He was endotracheally intubated, placed on mechanical ventilation, and required the use of midazolam, lorazepam, and propofol to control seizure activity.On admission to the ICU, the healthcare provider's initial orders included an I.V. propofol infusion. The initial order was to titrate the infusion to a maximum dose of 80 mcg/kg/minute according to the Ramsay Sedation Scale.3 There was no time limit ascribed to the infusion order.From 3 am on hospital day (HD)1 until 11 am on HD4, Mr. G received I.V. propofol. All visual seizure activity ceased; however, his bedside electroencephalogram (EEG) continued to show frequent brief bursts of single generalized sharp and slow wave complexes, occurring on average every 5 to 10 seconds, which remained unchanged after administration of I.V. fosphenytoin. For complete suppression of burst activity on the EEG, the propofol infusion was increased and continued for approximately 67 hours. Mr. G remained intubated on mechanical ventilation and hemodynamically stable until HD4, when his clinical status began to deteriorate. His BP and heart rate

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