https://doi.org/10.1177/10600280211017315 Annals of Pharmacotherapy 1–11 © The Author(s) 2021 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/10600280211017315 journals.sagepub.com/home/aop Research Report Introduction Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic by the World Health Organization in March 2020. 1 In the ongoing global crisis, it has been estimated that 15% to 20% of cases require hospitalization and 3% to 5% require intensive care. 2 Depending on defini- tions used and the degree of surging conditions, substantial worldwide variability has been reported with respect to the need for mechanical ventilation and outcomes of COVID- 19–related critical illness. Data from Atlanta, Georgia at the onset of the pandemic suggested that 76% of critically ill patients required mechanical ventilation, with a mortality rate of 36%. 2 By contrast, in 2 contemporaneous reports 3,4 from metropolitan New York City, including the authors’ own institution, 3 the need for critical care was estimated at 14%, the need for mechanical ventilation from 12% to 33%, and the mortality rate from 10% to 21%. Respiratory failure from COVID-19 is often severe and protracted; patients requiring mechanical ventilation often 1017315AOP XX X 10.1177/10600280211017315Annals of PharmacotherapyWitenko et al research-article 2021 1 NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA 2 Weill Cornell Medicine, New York, NY, USA Corresponding Author: Karen Berger, Department of Pharmacy, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th St, Rm K04, New York, NY 10065, USA. Email: karenberger7@gmail.com The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019 Corey J. Witenko, PharmD, BCPS, BCCCP 1 , Audrey J. Littlefield, PharmD, BCPS, BCCCP 1 , Sajjad Abedian, MS 2 , Anjile An, MPH 2 , Philip S. Barie, MD, MBA, MAMSE, MCCM 2 , and Karen Berger, PharmD, BCPS, BCCCP 1 Abstract Background: Propofol is commonly used to achieve ventilator synchrony in critically ill patients with coronavirus disease 2019 (COVID-19), yet its safety in this patient population is unknown. Objective: To evaluate the safety, in particular the incidence of hypertriglyceridemia, of continuous infusion propofol in patients with COVID-19. Methods: This was a retrospective study at 1 academic medical center and 1 affiliated teaching hospital in New York City. Adult, critically ill patients with COVID-19 who received continuous infusion propofol were included. Patients who received propofol for <12 hours, were transferred from an outside hospital while on mechanical ventilation, or did not have a triglyceride concentration obtained during the infusion were excluded. Results: A total of 252 patients were included. Hypertriglyceridemia (serum triglyceride concentration ≥ 400 mg/dL) occurred in 38.9% of patients after a median cumulative dose of 4307 mg (interquartile range [IQR], 2448-9431 mg). The median time to triglyceride elevation was 3.8 days (IQR, 1.9-9.1 days). In the multivariable regression analysis, obese patients had a significantly greater odds of hypertriglyceridemia (odds ratio = 1.87; 95% CI = 1.10, 3.21). There was no occurrence of acute pancreatitis. The incidence of possible propofol-related infusion syndrome was 3.2%. Conclusion and Relevance: Hypertriglyceridemia occurred frequently in patients with COVID-19 who received propofol but did not lead to acute pancreatitis. Elevated triglyceride concentrations occurred more often and at lower cumulative doses than previously reported in patients without COVID-19. Application of these data may aid in optimal monitoring for serious adverse effects of propofol in patients with COVID-19. Keywords sedatives, pancreatitis, adverse drug reactions, respiratory failure, critical care