SESSION TITLE: Critical Care Management of COVID-19
SESSION TYPE: Original Investigations
PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm
PURPOSE: Acute respiratory distress syndrome (ARDS), due to Coronavirus disease 2019 (COVID-19) Is associated with a significant rate of mortality. The ideal sedative(s) of choice in mechanically ventilated COVID-19 patients is still unclear. Here we report the clinical outcomes of using propofol for more than 48 hours vs any other sedative in such patients.
METHODS: This was a retrospective study of patients admitted to an intensive care unit (ICU) at Trumbull Regional Medical Centre and Sharon Regional Medical Centre between February 2020 and January 2022 with COVID-19 viral pneumonia. Our study consisted of 176 patients with moderate to severe ARDS as per Berlin’s criteria who were mechanically ventilated for atleast 48 hours. The primary outcome was mortality at 28 days from the date of intubation. Secondary outcomes included ventilator free days during the first 28 days after intubation (defined as being alive and free from mechanical ventilation), mortality at the end of hospitalization, length of stay, and readmission rate.
RESULTS: Out of 176 patients, 100 patients received sedation with propofol for more than 48 hours (test group) and 76 patients received other sedative agents or received propofol for less than 48 hours (control group). We compared the outcomes of the two different groups using paired t-test. The average age of the study population (63 vs 67 p=0.061), gender((0.44 vs 0.49 females p=0.54), BMI (34.93 vs 34.08 p=0.54), and oxygen requirement on admission (0.73 vs 0.64 p= 0.227) were not statistically different between the test and control groups respectively. Prevalence of comorbidities including diabetes, hypertension, chronic kidney disease, active cancer, and COPD were not significantly different between the two groups. There was a significant difference in the primary outcome of mortality at day 28 from intubation between the test and control group (0.62 vs 0.84 p=0.001). A significant difference in the secondary outcome of mortality at the end of hospitalization between the test group and control group (0.67 vs 0.84 p =0.009) was also observed. There were no statistically significant differences in the rest of secondary outcomes.
CONCLUSIONS: In this retrospective study, using propofol for more than 48 hours was associated with decreased mortality at day 28 (22%) as well as at end of hospitalization (17%) in mechanically ventilated COVID-19 patients. Propofol is known to have antiviral effects as well as immunosuppressive effects on biosynthesis of inflammatory cytokines by macrophages which is likely responsible for the mortality benefits that we encountered in this study.
CLINICAL IMPLICATIONS: Even though we found mortality benefits with using propofol in our study population, further investigations using prospective studies with a larger study population are required and clinicians need to be cautious with the complications associated with long term use of propofol.
DISCLOSURES: No relevant relationships by Arooj Ahmed
no disclosure submitted for Manuel Bautista;
No relevant relationships by Apeksha Gupta
No relevant relationships by Anirudh Jaglan
no disclosure on file for Saman Karki;
no disclosure submitted for Ritha Kartan;
No relevant relationships by Tamandeep Kaur
No relevant relationships by Sanjay Mahat
No relevant relationships by Krutarth Pandya
No relevant relationships by Stuti Patel
No relevant relationships by Janki Patel
no disclosure on file for Kim Porter;
No relevant relationships by Aayush Pradhan
No relevant relationships by Arun Pyakuryal
No relevant relationships by Pratik Saha
No relevant relationships by Parth Shah