Adaptation posologique des médicaments couramment utilisés en réanimation lors d’épuration extrarénale continue

Bourquin, Vincent; Ponte, Belén; Saudan, Patrick; Martin, Pierre‐Yves

doi:10.1016/j.nephro.2009.02.010

Cited by 7 publications

(5 citation statements)

References 44 publications

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“…(16%), mixed flora (16%) and Methicillin-resistant Staphylococcus aureus (9%). The most prescribed antibiotics and their dosage adjustment to high-volume CVVHDF are listed in Table 2 [15]. Thirty-one patients (56%) had thrombopoenia at the beginning of high-volume CVVHDF.…”

Section: Resultsmentioning

confidence: 99%

“…Because of the HVHF, our patients may have had inadequate plasma antibiotic levels. Despite the fact that, we were careful to properly adjust the dose of the antibiotics based on current recommendations, it is possible that the doses are sometimes inappropriate [15, 26]. Pharmacology studies assessing this point in patients undergoing CRRT found that antibiotic levels were insufficient most of the time for the antibiotics tested [27].…”

Section: Discussionmentioning

confidence: 99%

“…The haemofiltration was divided into one-third post-dilution and two-thirds pre-dilution according to our unit protocol. Temperature and serum electrolytes were monitored several times a day and drug dosage was adapted to avoid infra-therapeutic blood levels [15]. …”

Section: Methodsmentioning

confidence: 99%

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Use of high-volume haemodiafiltration in patients with refractory septic shock and acute kidney injury

Bourquin

Ponte

Pugin³

et al. 2012

Clin Kidney J

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BackgroundHigh-volume haemofiltration (HVHF) has been used successfully in animal models with sepsis, and preliminary data have shown that this technique may improve the haemodynamics in patients with refractory septic shock. We used high-volume continuous venovenous haemodiafiltration (CVVHDF) in patients with acute kidney injury (AKI) and refractory septic shock to evaluate their outcome when compared with their prognosis predicted by scores of severity.MethodsThis is a cohort study in a Medical and Surgical Intensive Care Unit. Fifty-five patients with refractory septic shock and AKI were included in the study.ResultsHigh-volume CVVHDF was started in patients with AKI and septic shock requiring norepinephrine dose >0.2 µg/kg/min. AKI was classified according to the RIFLE criteria. Treatment was implemented within the first 24 h of refractory septic shock with a dialysis dose of 70 mL/kg/h until reversal of shock or death. Fifty-five patients were treated with high-volume CVVHDF with an observed mortality of 63%, similar to the mortality predicted by the APACHE II and SAPS II scores.ConclusionSurvival rate in our patients with AKI and refractory septic shock treated with high-volume CVVHDF was identical to survival predicted by the severity scores. Treatment with high-volume haemodiafiltraton is applicable to severely ill patients with septic shock but does not confer any clear advantage in terms of survival. This therapy should not be implemented on a routine basis in patients with AKI and refractory septic shock.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Use of high-volume haemodiafiltration in patients with refractory septic shock and acute kidney injury

Bourquin

Ponte

Pugin³

et al. 2012

Clin Kidney J

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“…In addition, numerous factors clarifying altered drug exposure have been previously described in detail. [9][10][11][12][13][14] These are briefly described below and are summarized in Table 1.…”

Section: Rationale For Antibiotic Tdm In Patients Receiving Rrtmentioning

confidence: 99%

Therapeutic Drug Monitoring of Antibiotic Drugs in Patients Receiving Continuous Renal Replacement Therapy or Intermittent Hemodialysis: A Critical Review

Matusik

Boidin

Friggeri

et al. 2022

Therapeutic Drug Monitoring

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Purpose: Antibiotics are frequently used in patients receiving intermittent or continuous renal replacement therapy (RRT). Continuous renal replacement may alter the pharmacokinetics (PK) and the ability to achieve PK/pharmacodynamic (PD) targets. Therapeutic drug monitoring (TDM) could help evaluate drug exposure and guide antibiotic dosage adjustment. The present review describes recent TDM data on antibiotic exposure and PK/PD target attainment (TA) in patients receiving intermittent or continuous RRT, proposing practical guidelines for performing TDM.Methods: Studies on antibiotic TDM performed in patients receiving intermittent or continuous RRT published between 2000 and 2020 were searched and assessed. The authors focused on studies that reported data on PK/PD TA. TDM recommendations were based on clinically relevant PK/PD relationships and previously published guidelines.Results: In total, 2383 reports were retrieved. After excluding nonrelevant publications, 139 articles were selected. Overall, 107 studies reported PK/PD TA for 24 agents. Data were available for various intermittent and continuous RRT techniques. The study design, TDM practice, and definition of PK/PD targets were inconsistent across studies. Drug exposure and TA rates were highly variable. TDM seems to be necessary to control drug exposure in patients receiving intermittent and continuous RRT techniques, especially for antibiotics with narrow therapeutic margins and in critically ill patients. Practical recommendations can provide insights on relevant PK/PD targets, sampling, and timing of TDM for various antibiotic classes.Conclusions: Highly variable antibiotic exposure and TA have been reported in patients receiving intermittent or continuous RRT. TDM for aminoglycosides, beta-lactams, glycopeptides, linezolid, and colistin is recommended in patients receiving RRT and suggested for daptomycin, fluoroquinolones, and tigecycline in critically ill patients on RRT.

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“…In PD, drug removal occurs as the result of diffusion and concentration gradients. However, in PD during acute peritonitis a significant amount of drug binds to proteins and can be removed in peritoneal effluents [36,37,38]. …”

Section: Drug Removal By Dialysismentioning

confidence: 99%

A Quantitative Approach to Drug Dosing in Chronic Kidney Disease

Olyaei

Steffl²

2011

Blood Purif

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Chronic kidney disease (CKD) is increasing at an alarming rate. Medication prescribing in this growing population is especially difficult. Many pharmacological agents or their metabolites are eliminated unchanged through the kidney. Drug dosing in CKD is challenging as most patients have a number of comorbid conditions. Patients with CKD take pharmacological agents with potential for drug interactions. Most patients also have alterations to the normal functioning of a number of different organs or systems (e.g. heart, liver, gastrointestinal system) which affect pharmacokinetics of commonly used drugs in CKD. Pharmacokinetic behaviors of most drugs are highly variable in patients with CKD. In addition, pharmacological management of patients with CKD is imprecise and requires estimating renal function, applying clinical judgment and, if available, therapeutic drug monitoring to provide adequate pharmacotherapeutic concentrations to optimize pharmacodynamic response while minimizing toxicities. For drugs that are removed through the renal system unchanged, a dosing modification should be considered according to patient- and drug-specific factors. Renal replacement therapy and dialysis remove pharmacologic agents extensively, and thus a replacement dose is needed to avoid therapeutic failure. By applying a quantitative approach, health care providers can improve pharmacotherapeutic outcomes while reducing adverse drug reactions.

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Adaptation posologique des médicaments couramment utilisés en réanimation lors d’épuration extrarénale continue

Cited by 7 publications

References 44 publications

Use of high-volume haemodiafiltration in patients with refractory septic shock and acute kidney injury

Use of high-volume haemodiafiltration in patients with refractory septic shock and acute kidney injury

Therapeutic Drug Monitoring of Antibiotic Drugs in Patients Receiving Continuous Renal Replacement Therapy or Intermittent Hemodialysis: A Critical Review

A Quantitative Approach to Drug Dosing in Chronic Kidney Disease

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