Use of propofol in pediatric intensive care units: A national survey in Germany

Objective: Propofol is not licensed for sedation in pediatric intensive care medicine mainly due to the risk of propofol infusion syndrome. Nevertheless, it is applied by many pediatric intensive care units. The aim of this national survey was to asses the current use of propofol in pediatric intensive care units in Germany. Design: We performed a nationwide survey. The questionnaire assessed the intensive care unit type, patient numbers, dosing, duration, age and time limits, indications, side effects, and institutional protocols for propofol usage. Setting: Pediatric intensive care units in Germany. Subjects: Questionnaire about routine use of propofol sent to 214 pediatric departments. Interventions: None. Measurements and Main Results: One hundred ninety-four questionnaires (90.7%) were returned, ten had to be censored. The final analysis comprised 184 questionnaires (134 pediatric/neonatal intensive care units, 28 pediatric intensive care units, 22 neonatal intensive care units). Seventy-nine percent of intensive care units (n = 145 of 184) used propofol in children under the age of 16 yrs. Of these, 98% were for bolus application (n = 142 of 145), 78% for infusion >= 3 hrs (n = 113 of 145), and 33% for infusion. 3 hrs (n = 48 of 145). A lower age limit was applied by 52% (n = 75 of 145) and a dose limit by 51% (n = 74 of 145). The median dose limit was 4 mg/kg/hr; 48% (n = 70 of 145) used 3 mg/kg/hr or less. A time limit was applied by 98% (n = 46 of 47), 70% (n = 33 of 47) used it for <= 24 hrs, and 30% (n = 15 of 47) for >24 hrs. Main indications for propofol application were: difficult sedation (44%), postoperative ventilation (43%), and difficult extubation (30%). Seven cases of propofol infusion syndrome were reported by seven centers. Conclusions: This study shows that propofol is used off-license by many pediatric intensive care units in Germany. The majority of users has adopted tightly controlled regimens for propofol sedation, and limits the dose to. 3-4 mg/kg/hr and the maximum application time to 24-48 hrs. (Pediatr Crit Care Med 2012; 13:e150-e154)