Abstract:
OBJECTIVES:To outline the concepts involved in optimizing antibacterial dosing in critically ill patients with acute renal failure undergoing continuous renal replacement therapy (CRRT), provide a strategy for optimizing dosing, and summarize the data required to implement the strategy. DATA SOURCES:MEDLINE search from February 1986 to 2008. DATA EXTRACTION AND SYNTHESIS:Optimal dosing of antibacterials is dependent on achieving pharmacokinetic targets associated with maximal killing of bacteria and improved outcomes. The initial dose is dependent on the volume of distribution. Maintenance doses are dependent on clearance. Both should be adjusted according to the pharmacokinetic target associated with optimal bacterial killing, when known. The volume of distribution of some antibacterials is altered by critical illness or acute renal failure or both. Clearance by CRRT is dependent on the dose and mode of CRRT and the sieving or saturation coefficient of the drug. Both sieving and saturation coefficient are related to the plasma protein binding and thus may be altered in renal failure. CONCLUSIONS:Appropriate dose calculation requires knowledge of the pharmacokinetic target and the usual minimum inhibitory concentration of the suspected organism in the patient's locality (or if unavailable, the break point for the organism), published pharmacokinetic data (volume of distribution, non-CRRT clearance) on critically ill patients receiving CRRT (which may differ substantially from noncritically ill patients or those without renal failure), the sieving or saturation coefficient of the relevant drug in critically ill patients, the dose and mode of CRRT being used, and the actual dose of CRRT that is delivered. This large number of variables results in considerable inter- and intrapatient heterogeneity in dose requirements. This article provides basic principles and relevant data to guide the clinician in prescribing individualized dosing regimes.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Choi G,Gomersall CD,Tian Q,Joynt GM,Freebairn R,Lipman Jdoi
10.1097/CCM.0b013e3181aab3d0subject
Has Abstractpub_date
2009-07-01 00:00:00pages
2268-82issue
7eissn
0090-3493issn
1530-0293journal_volume
37pub_type
杂志文章,评审abstract:OBJECTIVE:To test the hypothesis that the effects of intravenous injection of latex particles would demonstrate the contribution of phagocytosis by mononuclear phagocytes to the development of Escherichia coli-induced acute lung injury in neutropenic guinea pigs. DESIGN:Prospective, controlled, experimental study. Int...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199606000-00025
更新日期:1996-06-01 00:00:00
abstract:OBJECTIVES:To measure energy expenditure in critically ill children and compare it with the energy expenditure predicted by recommended formulas, and relate the measured energy expenditure to nutritional and clinical indices. DESIGN:A prospective, clinical study. SETTING:Tertiary care pediatric intensive care unit in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200004000-00042
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVES:To evaluate the cardiovascular response and acute stress reaction after arousal induced by a benzodiazepine antagonist, flumazenil, in patients sedated with midazolam. DESIGN:Prospective study. SETTING:Emergency center in a university hospital. PATIENTS:A total of 12 patients were ventilated mechanically ...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200002000-00005
更新日期:2000-02-01 00:00:00
abstract::Suction applied to a chest-tube drainage system produces subambient pressure within the chest tube and may increase or decrease the flow of gas passing from the airway through a bronchopleural fistula. Such gas may have participated in gas exchange and contain more CO2 and less O2 than inspired gas. Calculated or meas...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198502000-00009
更新日期:1985-02-01 00:00:00
abstract:OBJECTIVE:To evaluate diagnostic and prognostic values of C-reactive protein (CRP) dosage in critically ill patients. DESIGN:Prospective, observational study. SETTING:Medical intensive care unit (ICU) in a university hospital. PATIENTS:A consecutive series of 74 patients admitted to the ICU. INTERVENTION:CRP measur...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200203000-00006
更新日期:2002-03-01 00:00:00
abstract:OBJECTIVE:To describe a case of hepatic subcapsular hematoma causing an acute Budd-Chiari-like syndrome, leading to hepatic compartment syndrome, which combines compression of intrahepatic vessels on CT, acute liver failure, and refractory shock. DESIGN:Case report. SETTING:Surgical ICU of a university teaching hospi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001403
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVE:Oxygenation measured 24 hours after acute respiratory distress syndrome onset more accurately stratifies risk, relative to oxygenation at onset, in both children and adults. However, waiting 24 hours is problematic, especially for interventions that are more efficacious early in the disease course. We aimed t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002958
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVE:Conventional outcomes research provides only percentage risk of such end points as mortality rate, utilization of resources, and/or broad groupings of multiple organ system dysfunction. These prognostications generally are not applicable to individual patients. The purpose of the present study was to determin...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200205000-00014
更新日期:2002-05-01 00:00:00
abstract::We used metoprolol orally or iv in 25 patients with multifocal atrial tachycardia that was complicating severe cardiopulmonary illness, and we observed its effect on heart rate and rhythm, BP, and arterial blood gases. All patients showed a dramatic slowing of heart rate, averaging 54.0 +/- 4.0 beat/min (p less than ....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198701000-00004
更新日期:1987-01-01 00:00:00
abstract:OBJECTIVES:Although the mortality of severe sepsis is easily quantified, the actual cause and timing of death from severe sepsis are less defined. We used the INDEPTH (International Integrated Database for the Evaluation of Severe Sepsis and Drotrecogin alfa activated) database to investigate the reported cause of deat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31820eda29
更新日期:2011-05-01 00:00:00
abstract:OBJECTIVE:To investigate the cardiorespiratory effects of graded bilateral pleural effusions in the anesthetized pig. DESIGN:Prospective, randomized, controlled, laboratory study. SETTING:Animal laboratory. SUBJECTS:Eleven male Yorkshire pigs. INTERVENTIONS:Animals were anesthetized using inhaled isoflurane. Orotra...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199903000-00040
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVE:The association between cigarette smoke exposure and the acute respiratory distress syndrome in patients with the most common acute respiratory distress syndrome risk factors of sepsis, pneumonia, and aspiration has not been well studied. The goal of this study was to test the association between biomarker-co...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001089
更新日期:2015-09-01 00:00:00
abstract::Hemodynamic effects of iso-oncotic 3% dextran-60, 6% dextran-70, and Ringer's acetate were compared in 28 male pigs (25 to 30 kg) subjected to experimental trauma and hemorrhage. The animals were kept anesthetized with 75% N2O/25% O2, 0.8% halothane. Hemodynamic and respiratory conditions were allowed to stabilize for...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198804000-00008
更新日期:1988-04-01 00:00:00
abstract::Standard techniques for measuring pulmonary resistance (RP) to gas flow in newborn infants yield results that are widely dispersed and difficult to interpret. The purpose of this study is to describe and evaluate a new improved method for determining RP which utilizes a sinusoidal pressure wave generator. Measurements...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198307000-00015
更新日期:1983-07-01 00:00:00
abstract:OBJECTIVE:To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence of ventilator-associated pneumonia, duration of mechanical ventilation, length of stay, and mortality in critically ill medical patients. DESIGN:Prospective, randomized, clinical study. SETTING:Three medical inte...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e3181bc8218
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVE:To demonstrate the efficacy and safety of an updated version of the nasal "bridle," which is used to prevent the accidental removal of small-bore nasoenteric feeding tubes. DESIGN:A descriptive study. SETTING:Surgical intensive care unit in a tertiary care hospital. PATIENTS:Twenty-six critically ill patie...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199603000-00011
更新日期:1996-03-01 00:00:00
abstract::Thirty-three patients underwent extensive cardiorespiratory monitoring during cardiac surgery. Recordings of measurements, with derived variables, were made preoperatively, postoperatively, and after extubation approximately 3 h after operation. The data provide a reference that allows decisions on whether the conditi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1981-07-01 00:00:00
abstract:OBJECTIVES:This study was designed to assess the effects on macrocirculation and microcirculation of adding an intra-aortic balloon pump to peripheral venoarterial extracorporeal membrane oxygenation in patients with severe cardiogenic shock and little/no residual left ventricular ejection. DESIGN:A prospective, singl...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000410
更新日期:2014-09-01 00:00:00
abstract:OBJECTIVE:To examine the relationship between aminoglycoside disposition kinetics and hemodynamic response to sepsis, as well as vital support therapy, in critically ill patients with sepsis. DESIGN:Cross-sectional study of critically ill patients with sepsis undergoing physiologic and aminoglycoside pharmacokinetic m...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199705000-00016
更新日期:1997-05-01 00:00:00
abstract:OBJECTIVES:We previously reported gene expression-based endotypes of pediatric septic shock, endotypes A and B, and that corticosteroid exposure was independently associated with increased mortality among pediatric endotype A patients. The Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial tested th...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004709
更新日期:2021-01-01 00:00:00
abstract:OBJECTIVE:Acute-phase proteins, such as C-reactive protein and albumin, may be related with course and outcome in status epilepticus, as changes of cytokine levels and blood-brain barrier breakdown during status epilepticus have been demonstrated. The aim of this study was to elucidate the association of C-reactive pro...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318287f2ac
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVES:Sepsis-associated changes of the arachidonic acid metabolism and the utility of arachidonic acid metabolites for the diagnosis of sepsis have been poorly investigated so far. Therefore, the primary objective of our study was to screen for differentially regulated arachidonic acid metabolites in septic patien...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182416f05
更新日期:2012-05-01 00:00:00
abstract:PURPOSES:To discuss the theoretical relationship of mean alveolar pressure to its most easily measured analog, the mean airway pressure, and to describe the key determinants, measurement considerations, and clinical implications of this index. DATA SOURCES:Relevant articles from the medical and physiologic literature,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1992-10-01 00:00:00
abstract:OBJECTIVE:To determine whether continuous gas flow in the breathing circuit or an airleak around the tracheal tube cuff will introduce errors into the measurement of oxygen consumption (VO2) with indirect calorimetry. DESIGN:Nonrandomized, controlled trial. SETTING:Experimental laboratory. SUBJECTS:Ten healthy, anes...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199209000-00023
更新日期:1992-09-01 00:00:00
abstract:OBJECTIVES:To determine bronchoalveolar lavage (BAL) fluid concentrations of keratinocyte growth factor (KGF) and hepatocyte growth factor (HGF), two potent growth factors for alveolar type II epithelial cells, in patients with acute respiratory distress syndrome (ARDS). DESIGN:Prospective study. SETTING:An adult tra...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200007000-00024
更新日期:2000-07-01 00:00:00
abstract::A commercially available gas-chromatograph (Sentorr Gas Analyzer, Ohio Medical Products, Madison, WI) was tested, featuring continuous measurement of in vivo PaO2 and PaCO2 by means of a thin, heparin-coated catheter, inserted through an indwelling arterial line. Gas tensions are displayed every 4 min. The probes had ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198007000-00011
更新日期:1980-07-01 00:00:00
abstract::Gastric mucosal damage occurs in critically ill patients in intensive care units and develops in the setting of severe physiologic stress. Within 24 hrs of admission to the intensive care unit, 75% to 100% of critically ill patients demonstrate evidence of stress-related mucosal disease. Stress ulcers present a risk o...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200206001-00002
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:To determine whether base excess, base excess caused by unmeasured anions, and anion gap can predict lactate in adult critically ill patients, and also to determine whether acid-base variables can predict mortality in these patients. DESIGN:Retrospective study. SETTING:Adult intensive care unit of tertiary ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000079819.27515.8E
更新日期:2003-08-01 00:00:00
abstract:BACKGROUND:Increased cardiac index, oxygen delivery (DO2), and oxygen consumption (VO2) patterns were shown to characterize the physiologic status of surviving high-risk surgical patients, and indicate increased metabolic needs; relatively normal DO2 and VO2 values were found to characterize the sequential pattern of n...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199105000-00014
更新日期:1991-05-01 00:00:00
abstract:OBJECTIVES:To evaluate the effect of a part-time rapid response system on the occurrence rate of cardiopulmonary arrest by comparing the times of rapid response system operation versus nonoperation. DESIGN:Retrospective cohort study. SETTING:A 1,360-bed tertiary care hospital. PATIENTS:Adult patients admitted to the...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002314
更新日期:2017-06-01 00:00:00