Association of preservative-free propofol use and outcome in critically ill patients

Background: Propofol is widely used to provide sedation to patients in the intensive care unit (ICU). This study examined whether preservative-free propofol infusion independently influences outcome in critically ill patients. Methods: This was a nested cohort study within a randomized controlled trial. ICU patients who received preservative-free propofol and those who did not were compared. The following data were collected: demographic information, APACHE II score, admission category, chronic severe illnesses, nutritional data, and blood glucose level and insulin dose. The main exposure was the use of preservative-free propofol infusion. The main outcomes were the occurrence of ICU-acquired infections, ICU-acquired sepsis, and ICU and hospital mortality. Results: A total of 523 patients were included (no propofol group, n = 399; propofol group, n = 124). After adjustment for differences in baseline characteristics, preservative-free propofol use was associated with increased risk of ICU-acquired infections (adjusted odds ratio [aOR], 1.89, 95% confidence interval [CI], 1.17-3.06; P = .009) and ICU-acquired severe sepsis and septic shock (aOR, 1.91; 95% CI, 1.12-3.28; P = .02), but not with ICU or hospital mortality. Conclusion: Preservative-free propofol infusion in critically ill patients may be associated with increased risk of ICU-acquired infections and ICU-acquired sepsis, with no significant difference in ICU or hospital mortality. This association might have been related to the use of preservative-free preparations.