Key points:
- The anesthetic propofol can cause cardiac arrest and severe hypotension if administered before tracheal intubation in critically ill patients.
- Tracheal intubation is currently severely under-researched.
- Alternative, low-risk methods for tracheal intubation are desperately needed, especially for critically ill patients.
New research part of a global project involving patients in intensive care has highlighted that propofol, an anaesthetic drug commonly used to facilitate invasive mechanical ventilation, increases cardiovascular complications risk in the critically ill.
The research is part of the International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE), which is investigating global practice in performing tracheal intubation in patients from 29 countries.
“Airway management is universal but prior to the INTUBE study data on the management of intubated patients has been scarce. Identifying risks is the first step in developing safer management approaches,” said lead researcher John Laffey, professor of anesthesia and intensive care medicine.
For patients who are critically ill, tracheal intubation is high-risk, as patients are more susceptible to adverse cardiovascular events like low blood pressure and even cardiac arrest. While most of the current research has focused on oxygenation optimization and methods to achieve intubation at the first attempt in order to reduce risk, Laffey and his team approached the problem from a different area—and detected a major risk factor.
During their study, the researchers found that propofol, a commonly used anaesthetic drug, is strongly associated with an increase in the incidence of cardiac arrest and severe hypotension after intubation. It appears the drug is a catch-22. Propofol suppresses reflexes, which makes it particularly good for intubation—but it is this suppression that is causing risks for critically ill patients.
Laffey and his team intent to conduct further clinical trials to develop and test alternative strategies for critically ill patients requiring tracheal intubation. But in the meantime, the researchers say their data “strongly suggests that propofol use should be restricted in this patient group and even avoided where possible.”
Information provided by National University of Ireland, Galway.