Impact of Propofol Sedation upon Caloric Overfeeding and Protein Inadequacy in Critically Ill Patients Receiving Nutrition Support

Abstract

Propofol, a commonly used sedative in the intensive care unit, is formulated in a 10% lipid emulsion that contributes 1.1 kcals per mL. As a result, propofol can significantly contribute to caloric intake and can potentially result in complications of overfeeding for patients who receive concurrent enteral or parenteral nutrition therapy. In order to avoid potential overfeeding, some clinicians have empirically decreased the infusion rate of the nutrition therapy, which also may have detrimental effects since protein intake may be inadequate. The purpose of this review is to examine the current literature regarding these issues and provide some practical suggestions on how to restrict caloric intake to avoid overfeeding and simultaneously enhance protein intake for patients who receive either parenteral or enteral nutrition for those patients receiving concurrent propofol therapy.

Improving nutrition practices for postoperative high‐risk heart transplant and ventricular assist device implant patients in circulatory compromise: A quality improvement pre– and post–protocol intervention outcome study

“…To optimize anti‐inflammatory effects, only omega‐3 enriched lipids were used 55 . The PN calorie goal target was 70%–80% of estimated calorie needs, 27,56 and limited dextrose loads were provided in the first postoperative week: 150–200 g/day (a glucose load that is sufficient in meeting metabolic demands of the brain and basic cellular function 57 , 58 ) with glucose infusion rates < 2 mg/kg/min.…”

Comment: The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019

“…Furthermore, because the median infusion dose of propofol at the time of hypertriglyceridemia was 50 µg/kg/min (40-60 µg/kg/min) and propofol (1 mL), which is dissolved in long-chain fatty acid (10%), produces 1.1 kcal/mL, patients with hypertriglyceridemia received 7.92 (6.336-9.504) kcal/kg/d from propofol. 5 Thus, propofol-induced calorie intake should be considered in the enteral nutrition of patients with COVID-19.…”

An analysis of nonnutritive calories from propofol, dextrose, and citrate among patients who are critically ill that are receiving continuous renal replacement therapy

“…Apart from enteral and/or parenteral sources, other sources of energy that patients who are critically ill may potentially receive include propofol, dextrose, and citrate 11–15 . These are also termed nonnutritive calories (NNCs).…”

“…These are also termed nonnutritive calories (NNCs). Propofol is a lipid‐soluble, short‐acting intravenous (IV) hypnotic sedative that induces unconsciousness in mechanically ventilated patients 15 . Dextrose infusion, a form of simple sugar/monosaccharide given intravenously, is often administered as maintenance fluids when patients are kept on nothing by mouth or fasting for procedures 6 …”

“…Apart from enteral and/or parenteral sources, other sources of energy that patients who are critically ill may potentially receive include propofol, dextrose, and citrate. [11][12][13][14][15] These are also termed nonnutritive calories (NNCs). Propofol is a lipid-soluble, short-acting intravenous (IV) hypnotic sedative that induces unconsciousness in mechanically ventilated patients.…”