Vancomycin continuous infusion versus intermittent infusion during continuous venovenous hemofiltration: slow and steady may win the raceReportar como inadecuado




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Annals of Intensive Care

, 5:10

First Online: 08 May 2015Received: 10 February 2015Accepted: 01 April 2015

Abstract

BackgroundVancomycin during continuous venovenous hemofiltration CVVH is either administered by intermittent infusion II or continuous infusion CI. In this patient population, the best method to rapidly achieve target serum concentrations of 15 mcg-ml to 25 mcg-ml remains to be elucidated. We hypothesized that CI would achieve a target serum level of 15 mcg-ml to 25 mcg-ml within 24 h of the initiation of therapy more consistently than II.

MethodsA retrospective cohort study of adult patients admitted to the intensive care unit ICU between 2011 and 2014 receiving intravenous vancomycin with 24-hour serum level while on CVVH was included. Patients were excluded from this review if they had residual renal function during CVVH, were concomitantly on extracorporeal membrane oxygenation, or if the first dose of vancomycin was received six or more hours prior to the initiation of CVVH. The primary outcome was the achievement of a therapeutic level of 15mcg-ml to 25 mcg-ml by 24 hours.

ResultsFifty-nine patients met the inclusion criteria and 14 received CI and 45 in II. Therapeutic 24-hour levels were achieved in 14-14 versus 2-45 in CI and II, respectively p < 0.001. Mean 24-hour vancomycin levels were 20.35 ± 2.78 mcg-ml for CI compared to 9.7 ± 3.52 mcg-ml for II p < 0.001. Mean loading dose was 26.65 ± 3.06 mg-kg for CI compared to 17.58 ± 5.72 mg-kg for II p < 0.001. Daily maintenance doses were 15.66 ± 6.26 mg-kg for CI compared to 17.28 ± 4.96 mg-kg for II p = 0.339. In the subgroup of 27 patients who received vancomycin-loading dose >20 mg-kg, mean 24-hour levels were 20.35 ± 2.78 mcg-ml for CI versus 11.8 ± 2.7 mcg-ml for II p < 0.001. No significant differences were found between patients in the two groups with respect to CVVH rate and length of CVVH prior to vancomycin administration.

ConclusionsThe results of our study suggest that critically ill patients on CVVH treated with CI achieved the target level faster than II and consistently keep the vancomycin level within target range.

KeywordsVancomycin Continuous infusion Continuous venovenous hemofiltration AbbreviationsCVVHcontinuous venovenous hemofiltration

CIcontinuous infusion

IIintermittent infusion

CRRTcontinuous renal replacement therapy

BMIbody mass index

APACHEIIAcute physiological and Chronic Health Score

AUCarea under the curve

MICminimum inhibitory concentration

SOFAsequential organ failure assessment

CVVHDcontinuous venovenous hemodialysis

CVVHDFcontinuous venovenous hemodiafiltration

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Autor: Hsin Lin - Yana Bukovskaya - Marc De Moya - Jarone Lee - Ulrich Schmidt

Fuente: https://link.springer.com/



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