Norepinephrine and vital organ blood flow during experimental hyperdynamic sepsis

Abstract

We conclude that hyperdynamic sepsis increases blood flow to heart, gut and kidney and that NE further increases cardiac output, blood pressure, myocardial performance, and urine output and creatinine clearance while maintaining regional blood flow.

Augmented renal clearance in the critically ill: Prevalence, risk factors, and implications for beta-lactam therapy

“…Specifically, although improvements in CL CR following intravenous fluid administration (68,201) and use of vasopressor agents (69,70) have been noted in large animal models, we did not observe any statistically significant difference in either the requirement for vasopressors (P = 0.173) or 24-hour fluid balance (P = 0.237) in those manifesting ARC. Importantly, these data could be misleading, as they represent information obtained around the time of drug dosing only and, therefore, fail to consider any prior interventions.…”

“…In this respect, evidence from large animal models demonstrate an increase in urine output and CL CR with crystalloid administration (68), in addition to an increase in CO, RBF, and CL CR (69,70) following initiation of vasopressor support. As such, in the absence of AKI (where dose reduction would be appropriate), the use of aggressive resuscitative strategies in the critically ill may potentially augment renal drug delivery and elimination (71).…”

Farmacocinética de vancomicina en niños hospitalizados en una unidad de paciente crítico

“…Para un adecuado uso de antimicrobianos en infecciones graves se deben considerar las variaciones de parámetros farmacocinéticos y farmacodinámicos (PK/ PD) debido al estado de inflamación sistémica (en inglés systemic inflammatory response syndrome-SIRS) 4,5 . Los parámetros PK/PD más relevantes para el uso de antimicrobianos que relacionan el tiempo de exposición del fármaco y su efecto farmacológico, son: el tiempo en que la concentración plasmática está sobre la concentración inhibitoria mínima del microorganismo (T > CIM), el valor en que la concentración máxima o pico se mantiene sobre la CIM del microorganismo (Cmax/CIM) y el área bajo la curva de exposición del fármaco en 24 h sobre la CIM (ABC 24 h/CIM) [6][7][8] .…”

Optimizing beta-lactam antibiotic dosing in critically ill patients: Prolonged infusion versus intermittent bolus administration

“…A major component of this inflammatory response is a hyperdynamic cardiovascular state, which is characterized by an increase in cardiac output (CO) and enhanced blood flow to major organs [111][112][113]. One of the major organs affected are the kidneys whereby the increase in renal blood flow associated with increases in CO leads to increases glomerular filtration rates (GFR) [109].…”

“…One of the major organs affected are the kidneys whereby the increase in renal blood flow associated with increases in CO leads to increases glomerular filtration rates (GFR) [109]. Furthermore, therapeutic interventions used to reverse hypotension in critically ill patients usually include large boluses of IV fluid and administration of vasopressor infusions, which are also associated with an early increase in CO and GFR [60,111,112,114,115]. Consequently, all of these factors lead to increased renal CL of some drugs, a phenomenon referred to as augmented renal clearance (ARC, defined as a creatinine clearance [CLCR] >130 mL/min).…”