Aminoglycoside Dosing Considerations in Intensive Care Unit Patients

1993 ◽  
Vol 27 (3) ◽  
pp. 351-357 ◽  
Author(s):  
Sharon M. Watling ◽  
Joseph F. Dasta
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Serum Concentrations ◽  
Once Daily ◽  
Factors Affecting ◽  
Study Selection ◽  
Aminoglycoside Toxicity ◽  
Dosing Regimens

OBJECTIVE: Factors affecting aminoglycoside dosing requirements in critically ill adult patients were reviewed. DATA SOURCES: A literature search was performed from 1979 to 1992 and articles pertaining to aminoglycoside dosing were obtained. STUDY SELECTION: Only studies appearing in peer-reviewed journals were selected. Topics selected included: Bactericidal kill kinetics, once-daily dosing regimens, critical illness, toxicity, aminoglycosides, intensive care unit, and lung penetration. CONCLUSIONS: Studies suggest that larger initial aminoglycoside doses are necessary in critically ill patients (tobramycin/gentamicin 3 mg/kg or amikacin 9 mg/kg) to achieve adequate peak serum concentrations. Current studies have not shown an increase in the incidence of aminoglycoside toxicity when using these larger initial doses. Follow-up monitoring is dependent upon the patient's physiology and risk factors for aminoglycoside-induced toxicity.

The role of IL-6 receptor inhibitor treatment in critical patient monitoring with COVID-19

2021 ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactate Dehydrogenase ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Group 2 ◽  
D Dimer

Objectives: The COVID-19 disease can manifest itself with acute respiratory distress syndrome, renal failure, and septic shock in critically ill patients. There are opinions that there is a correlation between high IL-6 levels and disease severity. In our intensive care unit, we evaluated the changes in the laboratory data and radiological involvement severity of our patients who underwent tocilizumab treatment and examined the appropriate laboratory parameter in the treatment follow-up and its effect on survival. Methods: In the critical patient follow-up of COVID-19, 17 of the 23 patients treated with tocilizumab had a mortal course (Group 1) and the remaining 6 (Group 2) were. The C-reactive protein, lactate dehydrogenase, IL-6, D-dimer, procalcitonin, albumin, and ferritin values, which were routinely screened in our clinic on the day of tocilizumab treatment and the 5th day after, were recorded. Both the change between the two groups and the change between days 1 and 5 were analyzed. Results: A total of 23 patients (55.35 ± 13.31 years) were included in the study. The computed tomography severity score assessed at the intensive care unit admission was statistically significantly higher in Group 2. The procalcitonin and lactate dehydrogenase values measured on day 5 after tocilizumab were significantly lower in Group 2. On the 5th day after treatment, the levels of C-reactive protein, ferritin, chest X-rays, IL-6 and D-dimer statistically significantly changed compared to the first day of the treatment. In correlation with the decrease in PCT as of the 5th day after tocilizumab administration, an increasing tendency was observed in 28-day survival. Conclusion: This study demonstrated that tocilizumab treatment may positively contribute to the treatment by decreasing cytokine levels. PCT and LDH follow-up before and after treatment in critically ill patients who are receiving tocilizumab treatment can give an idea about survival.

FACTORS AFFECTING INTENSIVE CARE AND MORTALITY IN SARS-CoV 2019 HOSPITAL PATIENTS

2021 ◽  
pp. 7-11
Author(s):  
Gulfidan Uzan ◽  
Bedriye Kar ◽  
Evren Canel Karakas ◽  
Macit Koldas ◽  
Mehmet Mesut Sonmez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Laboratory ◽  
Treatment Options ◽  
Shortness Of Breath ◽  
Factors Affecting ◽  
Laboratory Parameters ◽  
Radiological Data ◽  
Hospital Patients

Backround: Information on prognosis and treatment in COVID-19 is limited and variable. We wanted to report the demographic, clinical, laboratory, radiological data and treatment and follow-up results of our patients diagnosed with COVID-19 in the study and to determine the factors affecting prognosis and mortality. Materials-methods: The study included 1161 inpatients with PCR positive and/or radiologically diagnosed COVID-19 pneumonia. Of these, 151 patients were taken to the intensive care unit and 37 patients were intubated. The data obtained through the system were evaluated retrospectively and observationally. Results: The mean age of 1161 inpatients was 54.5 years and 616 (53.1%) were male. 104 (8.9%) of 1161 inpatients died. 151 (13%) were taken to the intensive care unit. Of these, 37 (24.5%) were intubated. The analysis revealed age(p<0.001), gender(p<0.001), presence of comorbid disease (p<0.001), cough(p<0.001), shortness of breath (p<0.001), fatigue and malaise symptoms (p<0.001) and in the laboratory and signicant correlation was found with some laboratory parameters and some treatment options (p<0.001).When the living and deceased patients were compared; age (p<0.001), gender(p=0.001), presence of additional disease (p<0.001), cough(p<0.001), shortness of breath (p<0.001), malaise and fatigue symptoms (p<0.001), in the laboratory; signicant correlation was found with some laboratory parameters and some treatment options (p<0.001).Conclusion: We believe that these data obtained in our study will be important in predicting prognosis and mortality and in effective patient management. We wanted to emphasize that hydroxychloroquine, favipravir, methylprednisolone and enoxoparin are effective in reducing mortality in the treatment.

Long-Term Outcome of Critically Ill Renal Transplant Recepients After Admission to Intensive Care Unit: A 5-Year Follow-Up.

2014 ◽  
Vol 98 ◽  
pp. 68
Author(s):  
D. Khadzhynov ◽  
F. Halleck ◽  
D. Schmidt ◽  
F. Petereit ◽  
T. Slowinski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Renal Transplant ◽  
Critically Ill ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Pharmacokinetics of Ertapenem in Critically Ill Patients Receiving Continuous Venovenous Hemodialysis or Hemodiafiltration

2013 ◽  
Vol 58 (3) ◽  
pp. 1320-1326 ◽  
Author(s):  
Rachel F. Eyler ◽  
A. Mary Vilay ◽  
Ahmed M. Nader ◽  
Michael Heung ◽  
Melissa Pleva ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Simulated Patients ◽  
Total Serum ◽  
Serum Concentrations ◽  
Once Daily ◽  
Continuous Venovenous Hemodiafiltration ◽  
Continuous Venovenous Hemodialysis ◽  
Dosing Regimens ◽  
Carbapenem Antibiotic

ABSTRACTThis study characterizes the pharmacokinetics of ertapenem, a carbapenem antibiotic, in critically ill adult subjects receiving continuous renal replacement therapy (CRRT). Eight critically ill patients with suspected/known Gram-negative infections receiving continuous venovenous hemodialysis (CVVHD) or continuous venovenous hemodiafiltration (CVVHDF) and ertapenem were enrolled. One gram of ertapenem was infused over 30 min. Predialyzer blood samples were drawn with the first dose of ertapenem from the hemodialysis tubing at time zero, 30 min, and 1, 2, 4, 8, 12, 18, and 24 h after the start of the ertapenem infusion. Effluent was collected at the same time points. Ertapenem total serum, unbound serum, and effluent concentrations from all eight subjects were used simultaneously to perform a population compartmental pharmacokinetic modeling procedure using NONMEM. Monte Carlo simulations were performed to evaluate the ability of several ertapenem dosing regimens (500 mg once daily, 750 mg once daily, 500 mg twice daily, and 1,000 mg once daily) to obtain effective unbound serum concentrations above 0.5, 1, and 2 μg/ml. For our simulated patients, all regimens produced unbound ertapenem concentrations above 2 μg/ml for 40% of the dosing interval for at least 96% of simulated patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT00877370.)

scholarly journals Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e134-e138
Author(s):  
Anke Pape ◽  
Jan T. Kielstein ◽  
Tillman Krüger ◽  
Thomas Fühner ◽  
Reinhard Brunkhorst
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomized Trials ◽  
Clinical Course ◽  
Pharmacological Therapy ◽  
The European Union ◽  
Positive Effects ◽  
Special Patient

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has a serious impact on health and economics worldwide. Even though the majority of patients present with moderate and mild symptoms, yet a considerable portion of patients need to be treated in the intensive care unit. Aside from dexamethasone, there is no established pharmacological therapy. Moreover, some of the currently tested drugs are contraindicated for special patient populations like remdesivir for patients with severely impaired renal function. On this background, several extracorporeal treatments are currently explored concerning their potential to improve the clinical course and outcome of critically ill patients with COVID-19. Here, we report the use of the Seraph 100 Microbind Affinity filter, which is licensed in the European Union for the removal of pathogens. Authorization for emergency use in patients with COVID-19 admitted to the intensive care unit with confirmed or imminent respiratory failure was granted by the U.S. Food and Drug Administration on April 17, 2020.A 53-year-old Caucasian male with a severe COVID-19 infection was treated with a Seraph Microbind Affinity filter hemoperfusion after clinical deterioration and commencement of mechanical ventilation. The 70-minute treatment at a blood flow of 200 mL/minute was well tolerated, and the patient was hemodynamically stable. The hemoperfusion reduced D-dimers dramatically.This case report suggests that the use of Seraph 100 Microbind Affinity filter hemoperfusion might have positive effects on the clinical course of critically ill patients with COVID-19. However, future prospective collection of data ideally in randomized trials will have to confirm whether the use of Seraph 100 Microbind Affinity filter hemoperfusion is an option of the treatment for COVID-19.

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