Propofol is associated with lower mortality in sepsis-associated encephalopathy

1. Among patients with sepsis-associated encephalopathy, propofol monotherapy was associated with lower one-year all-cause mortality compared to no sedation therapy.

Evidence Rating Level: 2 (Good)

Sepsis-associated encephalopathy (SAE) involves acute progressive brain dysfunction in the absence of direct central nervous system infection. Mortality rate increases with SAE severity. Among critically ill patients, it is important to address distress to reduce the risk of acute and chronic physical and emotional harm. The sedative agents propofol or dexmedetomidine have been recommended for patients with agitation due to anxiety who need ongoing intravenous sedation. However, no large-scale cohort studies have investigated whether sedation therapy independently correlates with one-year all-cause mortality following intensive care unit (ICU) admission. This study thus examined the relationship between sedation therapy and one-year all-cause mortality. This retrospective cohort study used data from the Medical Information Mart for Intensive Care (MIMIC)-IV and included patients in the US aged 18-89 with SAE who were treated within the first 24h of admission to the ICU. Sedation therapy was defined as administering propofol, midazolam, dexmedetomidine, or any combination. Among the 4,618 patients included in the study (mean [SD] age = 66.8 +14.7 years, male [%] = 2762 [59.8]), 3,343 were in the sedative and 1,275 in the non-sedative use groups. Compared to SAE patients who did not receive sedation, administering propofol alone was associated with 49% reduced one-year all-cause mortality (hazard ratio [HR], 0.51; 95% CI, 0.40–0.65). The interaction between propofol monotherapy and ventilation support increased one-year all-cause mortality (HR, 0.70; 95% CI, 0.49–1.00, P for interaction = 0.041). Overall, this study found that compared to no sedation therapy, sedation with propofol was associated with lower one-year all-cause mortality among patients with SAE, although ventilation support attenuated the protective effect. These findings highlight the potential benefit of choosing propofol monotherapy for patients with SAE who require sedation. 

Click here to read the study in PLOS One

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