There is some literature that propofol may be better for sedation in the mechanically ventilated patient, yet many emergency physicians still do not have access to the medication
Lorazepam infusions are frequently used in many EDs for sedation of the mechanically ventilated patient
Patients receiving continuous infusions of lorazepam are at risk for propylene glycol toxicity
Propylene glycol toxicity primarily causes a metabolic acidosis and acute tubular necrosis
Critically ill patients with renal or hepatic dysfunction are at increased risk of toxicity
Monitoring propylene glycol levels are impractical
Rather, check the osmol gap: a gap > 10 - 15 reflects significany propylene glycol accumulation
Hemodialysis effectively removes propylene glycol
References
Devlin JW, Roberts RJ. Pharmacology of commonly used analgesics and sedatives in the ICU: benzodiazepines, propofol, and opioids. Crit Care Clin 2009;25:431-49.
