Propofol is the most widely used sedative in ICU. It is also administered entirely without measuring the blood concentration that determines its effect.¹ Clinicians adjust infusion rates based on behavioural observation, responsiveness, movement, grimacing, rather than on any knowledge of what is actually circulating in the blood. In a drug with significant inter-patient variability in metabolism and clearance,² that is a structural gap between intention and reality.

Scoring systems such as RASS and SAS assess behavioural response, not drug concentration.³ They cannot detect accumulation at a molecular level, and they cannot distinguish between appropriate sedation and unintended overexposure.⁴ The result is predictable: despite guidelines favouring lighter, individualised sedation, deep sedation remains common in mechanically ventilated patients.⁵

The consequences compound. Excess sedation delays spontaneous breathing trials and prolongs mechanical ventilation.⁶ Prolonged ventilation increases the risk of ventilator-associated pneumonia and other hospital-acquired infections.⁷ Sedation depth and duration are independently associated with ICU delirium,⁸ which affects up to 80% of ventilated patients, increases 1-year mortality, and is linked to persistent cognitive impairment after discharge.⁹

Each additional day of delirium increases mortality risk.¹⁰ All of this flows, at least in part, from dosing without measurement.

Critically ill patients are not “average.” Organ dysfunction, inflammation, age, body composition, concurrent therapies, and inherited differences in drug metabolism all influence how propofol behaves in any individual.² The same dose can produce very different blood concentrations in different patients, and population-level genetic variation means dose requirements may also differ across ethnic groups.²

Without directly measuring concentration, clinicians are effectively dosing blind, estimating effect based on behaviour rather than knowing how much drug is actually circulating. The difference between optimal sedation and unintended accumulation is therefore often invisible until complications emerge.¹¹

ProSed® changes that. By providing rapid, near-patient measurement of blood propofol concentration, sedation shifts from subjective assessment to objective pharmacology.¹ Clinicians can see, in real time, the relationship between administered dose and circulating level, regardless of a patient’s physiology, background, or metabolic profile.

Measured concentration enables safer titration toward defined therapeutic ranges associated with lighter, safer sedation.¹² Earlier detection of accumulation allows timely dose adjustment before deep sedation takes hold.¹² More precise titration strengthens spontaneous awakening trials, supports earlier extubation, and reduces unnecessary ventilation duration in appropriately selected patients.⁶

Objective measurement also improves adherence to structured care pathways such as the ABCDEF bundle, where sedation optimisation is central to delirium prevention and early mobilisation.¹³ Consistent data reduces inter-clinician variability and strengthens the defensibility of clinical decision-making.

Sedation transitions from empirical estimation to precision pharmacology.

The patient benefits. So does the hospital.