PMID- 20457687
OWN - NLM
STAT- MEDLINE
DCOM- 20100727
LR  - 20131121
IS  - 1098-4275 (Electronic)
IS  - 0031-4005 (Linking)
VI  - 125
IP  - 6
DP  - 2010 Jun
TI  - Partial-exchange blood transfusion: an effective method for preventing mortality 
      in a child with propofol infusion syndrome.
PG  - e1493-9
LID - 10.1542/peds.2009-1823 [doi]
AB  - Here we describe a case of propofol-related infusion syndrome (PRIS) in a child 
      with malignant refractory status epilepticus treated with partial-exchange blood 
      transfusion (PEBT), an innovative method of resuscitation that has the potential 
      to reduce the mortality rate associated with this syndrome. Our patient is a 
      4-year-old boy with malignant status epilepticus associated with bacterial 
      meningitis. Propofol was used because of persistent seizure activity refractory 
      to adequate doses of phenytoin, phenobarbital, levetiracetam, and midazolam 
      infusion at 0.7 mg/kg per hour. Propofol was escalated from 0.6 mg/kg per hour to 
      an electroencephalogram-burst-suppressing dose of 15.6 mg/kg per hour. Signs of 
      PRIS were noticed after 48 hours on propofol. The severe bradycardia responded 
      only to infusions of calcium gluconate. PEBT corrected all the cardiac 
      abnormalities and returned enough hemodynamic stability to permit continuous 
      veno-venous hemodialysis for renal failure and removal of toxins. PEBT is a safe 
      and innovative option for correcting the metabolic abnormalities that result in 
      cardiac dysfunction, which is typically the most serious and usually terminal 
      event in PRIS. When done with small aliquots, it avoids the severe hemodynamic 
      instability that is usually a hindrance with hemodialysis, continuous veno-venous 
      hemodialysis, and extracorporeal membrane oxygenation, which are other methods of 
      supporting these children during the crisis that are mentioned in the literature.
FAU - Da-Silva, Shonola S
AU  - Da-Silva SS
AD  - Pediatric Critical Care Medicine, Pediatric Intensive Care Unit, Children's 
      Regional Hospital, One Cooper Plaza, Camden, NJ 08103, USA. 
      dasilva-shonola@cooperhealth.edu
FAU - Wong, Ronald
AU  - Wong R
FAU - Coquillon, Patricia
AU  - Coquillon P
FAU - Gavrilita, Cristina
AU  - Gavrilita C
FAU - Asuncion, Arsenia
AU  - Asuncion A
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20100510
PL  - United States
TA  - Pediatrics
JT  - Pediatrics
JID - 0376422
RN  - 0 (Hypnotics and Sedatives)
RN  - YI7VU623SF (Propofol)
SB  - IM
MH  - Child, Preschool
MH  - Electroencephalography
MH  - Exchange Transfusion, Whole Blood/*methods
MH  - Humans
MH  - Hypnotics and Sedatives/administration & dosage/*adverse effects
MH  - Infusions, Intravenous
MH  - Male
MH  - Propofol/administration & dosage/*adverse effects
MH  - Status Epilepticus/*drug therapy
MH  - Syndrome
MH  - Treatment Failure
EDAT- 2010/05/12 06:00
MHDA- 2010/07/28 06:00
CRDT- 2010/05/12 06:00
PHST- 2010/05/12 06:00 [entrez]
PHST- 2010/05/12 06:00 [pubmed]
PHST- 2010/07/28 06:00 [medline]
AID - peds.2009-1823 [pii]
AID - 10.1542/peds.2009-1823 [doi]
PST - ppublish
SO  - Pediatrics. 2010 Jun;125(6):e1493-9. doi: 10.1542/peds.2009-1823. Epub 2010 May 
      10.