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. 2025 Mar;31(3):e70273.
doi: 10.1111/cns.70273.

The Relationship Between the Average Infusion Rate of Propofol and the Incidence of Delirium During Invasive Mechanical Ventilation: A Retrospective Study Based on the MIMIC IV Database

Qi-Yue Ge  1   2 , Chao Zheng  3 , Xiao-Bin Song  4 , Zhuang-Zhuang Cong  5 , Jing Luo  5 , Hao-Tian Zheng  1   2 , Peng-Long Zhao  4 , Yan-Qing Wang  6 , Bing-Wei Chen  7 , Yi Shen  1   2
Affiliations

The Relationship Between the Average Infusion Rate of Propofol and the Incidence of Delirium During Invasive Mechanical Ventilation: A Retrospective Study Based on the MIMIC IV Database

Qi-Yue Ge et al. CNS Neurosci Ther. 2025 Mar.

Abstract

Background: Delirium is a common complication observed in intensive care units (ICUs). Propofol is one of the most widely used sedatives and is believed to be closely connected with the incidence of delirium. The study was carried out to explore the relationship between delirium and the average rate of propofol infusion.

Methods: Patients who underwent invasive mechanical ventilation (IMV) while receiving propofol from the Medical Information Mart for Intensive Care IV (MIMIC IV) database were included in the study. The primary outcome was to identify the potential risk factors for the incidence of delirium and investigate the relationship between the average rate of propofol infusion and the incidence of delirium. The secondary outcome was to further analyze the relationship by subgroup analysis. Propensity score matching (PSM) was employed to minimize bias.

Results: A total of 16,956 patients (delirium: 5805; control: 11,151) were ultimately included in the study after PSM. The median diagnostic time of delirium was 18 h. An average propofol infusion rate ≥ 20 μg/(kg*h) during the initial 18 h was found to be independently significant [OR = 1.84, 95% CI = (1.72, 1.98), p < 0.001], while an average propofol infusion rate ≤ 40 μg/(kg*h) in the first hour showed no statistically significant difference in the incidence of delirium [OR = 0.95, 95% CI = (0.88, 1.02), p = 0.163]. Besides, an average propofol infusion rate ≥ 20 μg/(kg*h) was also found to be statistically significant in all the subgroup analyses.

Conclusion: An average propofol infusion rate ≥ 20 μg/(kg*h) during the initial 18 h was identified as an independent risk factor for delirium, suggesting that the accumulation of propofol might be associated with an increased incidence of delirium.

Keywords: delirium; invasive mechanical ventilation; odds ratio; propofol.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of patient selection.
FIGURE 2
FIGURE 2
Visualization of the average rate of propofol infusion. (a) Average rate of propofol infusion before PSM. Median delirium diagnosis time after the first postoperative propofol infusion was 18.89 h; (b) Average rate of propofol infusion after PSM. Median delirium diagnosis time after the first postoperative propofol infusion was 18.00 h.
FIGURE 3
FIGURE 3
RCS plot and stacked bar chart of the initial 18 h. (a) RCS plot of the initial 18 h. Average propofol infusion rate of ≥ 20 μg/(kg*h) in the initial 18 h was selected as an indicator to differentiate between high and low risks of delirium; (b) Stacked bar chart showing the proportion of delirium patients in high‐risk and low‐risk groups during the first 18 h.
FIGURE 4
FIGURE 4
Forest plot of the subgroup analysis. Subgroup analyses for age, gender, race, and last care unit. Logistic regression model was used to assess the impact of average propofol infusion rate ≥ 20 μg/(kg*h) in the initial 18 h.
See this image and copyright information in PMC

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