Reliability of mini-bronchoalveolar lavage for the measurement of epithelial lining fluid concentrations of tobramycin in critically ill patients

2007 ◽  
Vol 33 (9) ◽  
pp. 1519-1523 ◽  
Author(s):  
Emmanuel Boselli ◽  
Dominique Breilh ◽  
Sarah Djabarouti ◽  
Christian Guillaume ◽  
Thomas Rimmelé ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Epithelial Lining ◽  
Epithelial Lining Fluid

scholarly journals Pulmonary Epithelial Lining Fluid Concentrations after Use of Systemic Amphotericin B Lipid Formulations

2009 ◽  
Vol 53 (11) ◽  
pp. 4934-4937 ◽  
Author(s):  
Stefan Weiler ◽  
Gerda Falkensammer ◽  
Angelika Hammerer-Lercher ◽  
Markus Anliker ◽  
Helene Vogelsinger ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Colloidal Dispersion ◽  
Standard Errors ◽  
Epithelial Lining ◽  
Lipid Complex ◽  
Epithelial Lining Fluid ◽  
Lipid Formulations

ABSTRACT Amphotericin B (AMB) concentrations were determined in pulmonary epithelial lining fluid (ELF) of 44 critically ill patients, who were receiving treatment with liposomal AMB (LAMB) (n = 11), AMB colloidal dispersion (ABCD) (n = 28), or AMB lipid complex (ABLC) (n = 5). Mean AMB levels (± standard errors of the means) in ELF amounted to 1.60 ± 0.58, 0.38 ± 0.07, and 1.29 ± 0.71 μg/ml in LAMB-, ABCD-, and ABLC-treated patients, respectively (differences are not significant).

Evaluation of Epithelial Lining Fluid Concentration of Amikacin in Critically Ill Patients With Ventilator-Associated Pneumonia

2018 ◽  
Vol 35 (4) ◽  
pp. 400-404 ◽  
Author(s):  
Farhad Najmeddin ◽  
Bita Shahrami ◽  
Sayna Azadbakht ◽  
Mehrnoush Dianatkhah ◽  
Mohammad Reza Rouini ◽  
...  
Keyword(s):  
Critically Ill ◽  
Lung Tissue ◽  
Critically Ill Patients ◽  
Peak Plasma ◽  
Plasma Concentrations ◽  
Adult Patients ◽  
Ventilator Associated Pneumonia ◽  
Epithelial Lining ◽  
Epithelial Lining Fluid ◽  
The Mean

Introduction: Classically, aminoglycosides are known to have low penetration into the lung tissue. So far, no study has been conducted on human adult patients to evaluate amikacin concentration in epithelial lining fluid (ELF) of the alveoli. Therefore, convincing data are not available from the perspective of pharmacokinetics to support the fact that a dosage of 20 mg/kg of amikacin is sufficient to treat patients with ventilator-associated pneumonia (VAP). Method: This was a pilot study of amikacin concentration measurement in the alveolar site of action in critically ill adult patients with VAP who required aminoglycoside therapy. A dose of 20 mg/kg of amikacin was administered over a 30-minute infusion. The serum concentrations of amikacin were evaluated in the first, second, fourth, and sixth hours. However, the ELF concentration of amikacin was evaluated in the second hour with the help of bronchoalveolar lavage sampling technique. Results: A total number of 8 patients was included in the study. The mean (SD) administered dose was 20 (0.9) mg/kg. The mean (SD) peak plasma concentration of amikacin was 59.6 (23) mg/L, with the volume of distribution of 0.36 (0.13)L/kg. The amikacin concentration in ELF was successfully measured in 7 patients (6.3) mg/L. The lung tissue penetration of the drug was described as alveolar percentage, proportional to both the first- and second-hour plasma concentrations, with a mean (SD) of 10.1% (8.4%) and 18% (16.7%), respectively. Conclusion: To our knowledge, the current study is the first that investigates whether standard doses of amikacin may lead to sufficient alveolar concentration of the drug. The results show that administration of amikacin in doses of 20 mg/kg in critically ill patients with VAP may not provide sufficient concentrations in ELF.

scholarly journals Cardiopulmonary effects of bronchoalveolar lavage in critically ill patients with ventilator-associated pneumonia

Critical Care ◽  
10.1186/cc817 ◽  
2000 ◽  
Vol 4 (Suppl 1) ◽  
pp. P97
Author(s):  
A Koroneos ◽  
I Kalomenidis ◽  
F Moraitou ◽  
P Polakis ◽  
S Papanikolaou ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Ventilator Associated Pneumonia

scholarly journals Intrapulmonary steady-state concentrations of clarithromycin and azithromycin in healthy adult volunteers.

1997 ◽  
Vol 41 (6) ◽  
pp. 1399-1402 ◽  
Author(s):  
K A Rodvold ◽  
M H Gotfried ◽  
L H Danziger ◽  
R J Servi
Keyword(s):  
Steady State ◽  
Standard Deviation ◽  
Bronchoalveolar Lavage ◽  
Drug Administration ◽  
Alveolar Macrophages ◽  
Healthy Adult ◽  
Epithelial Lining ◽  
Epithelial Lining Fluid ◽  
Adult Volunteers

The steady-state concentrations of clarithromycin and azithromycin in plasma were compared with concomitant concentrations in epithelial lining fluid (ELF) and alveolar macrophages (AM) obtained in intrapulmonary samples during bronchoscopy and bronchoalveolar lavage from 40 healthy, nonsmoking adult volunteers. Mean plasma clarithromycin, 14-(R)-hydroxyclarithromycin, and azithromycin concentrations were similar to those previously reported. Clarithromycin was extensively concentrated in ELF (range of mean +/- standard deviation concentrations, 34.4 +/- 29.3 microg/ml at 4 h to 4.6 +/- 3.7 microg/ml at 24 h) and AM (480 +/- 533 microg/ml at 4 h to 99 +/- 50 microg/ml at 24 h). The concentrations of azithromycin in ELF were 1.01 +/- 0.45 microg/ml at 4 h to 1.22 +/- 0.59 microg/ml at 24 h, and those in AM were 42.7 +/- 28.7 microg/ml at 4 h to 41.7 +/- 12.1 microg/ml at 24 h. The concentrations of 14-(R)-hydroxyclarithromycin in the AM ranged from 89.3 +/- 52.8 microg/ml at 4 h to 31.3 +/- 17.7 microg/ml at 24 h. During the period of 24 h after drug administration, azithromycin and clarithromycin achieved mean concentrations in ELF and AM higher than the concomitant concentrations in plasma.

scholarly journals Pharmacokinetics and intrapulmonary concentrations of high-dose tigecycline in critically ill patients with severe infections

2020 ◽  
Author(s):  
Gennaro De Pascale ◽  
Lucia Lisi ◽  
Gabriella Maria Pia Ciotti ◽  
Maria Sole Vallecoccia ◽  
Salvatore Lucio Cutuli ◽  
...  
Keyword(s):  
Critically Ill ◽  
Nosocomial Pneumonia ◽  
Critically Ill Patients ◽  
Group Differences ◽  
High Dose ◽  
Epithelial Lining Fluid ◽  
Combination Strategies ◽  
Severe Infections ◽  
Abdominal Infections ◽  
Mic Value

Abstract Background In critically ill patients, the use of high tigecycline dosages (HD TGC) (200 mg/day) has been recently increasing but few pharmacokinetic/pharmacodynamic (PK/PD) data are available. We investigated plasmatic and pulmonary concentrations of HD TGC in the treatment of severe infections. Methods This was a single centre, prospective, observational study that was conducted in the twenty-bed mixed ICU of a 1,500- bed teaching hospital in Rome, Italy. In all patients admitted to the ICU between 2015 and 2018, who received TGC (200 mg loading dose, then 100 mg q12) for the treatment of documented infections, serial blood samples were collected to measure TGC concentrations. Moreover, epithelial lining fluid (ELF) concentrations were determined in patients with nosocomial pneumonia. Results Among the 32 non-obese patients included, 11 had a treatment failure, while the other 21 subjects successfully eradicated the infection. There were no between-group differences in terms of demographic aspects and main comorbidities. In nosocomial pneumonia, for a target AUC0-24/MIC of 4.5, 75% of the patients would be successfully treated in presence of 0.5 mg/L MIC value and all the patients obtained the PK target with MIC≤0.12 mg/mL. In intra-abdominal infections, for a target AUC0-24/MIC of 6.96, at least 50% of the patients would be adequately treated against bacteria with MIC≤0.5 mcg/mL. Finally, in skin and soft-tissue infections, for a target AUC0-24/MIC of 17.,9 only 25% of the patients obtained the PK target at MIC values of 0.5 mg/L and less than 10% were adequately treated against germs with MIC value ≥1 mcg/ml. HD TGC showed a relevant pulmonary penetration with a median and IQR ELF/plasma ratio (%) of 152.9 [73.5-386.8]. Conclusions The use of HD TGC is associated with satisfactory plasmatic and pulmonary concentrations for the treatment of severe infections due to fully susceptible bacteria (MIC<0.5 mg/L). Even higher dosages and combination strategies are required in presence of difficult to treat pathogens.

scholarly journals The role of mini-bronchoalveolar lavage fluid in the diagnosis of pulmonary tuberculosis in critically ill patients

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Cynthia Pessoa Neves ◽  
Allyson Guimarães Costa ◽  
Izabella Picinin Safe ◽  
Alexandra de Souza Brito ◽  
Jaquelane Silva Jesus ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Bronchoalveolar Lavage ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Bronchoalveolar Lavage Fluid ◽  
Lavage Fluid
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