[Drugs in the intensive care unit--need for dosage adjustment in organ failure]

Drug dosage in intensive care patients is a common problem that cannot be sufficiently solved in practice. To obtain an idea as to the variance of multiorgan failure during treatment, the pharmacokinetics of 17 drugs were evaluated in 96 patients. Continuous hemofiltration served as a model for constant elimination rates. In addition, the elimination of drugs was investigated during extracorporeal lung support. For 11 of 15 drugs on which kinetic studies had been completed, dose reductions had to be performed. Furthermore, widespread variance in their volume of distribution and their clearance and in the extrarenal fraction of elimination were detected. The latter showed a close correlation to clinical scores of illness. This led us to develop a new algorithm for primary estimations of drug dosage during hemofiltration. In a preliminary validation study, the algorithm seemed to show an improvement in the drug dosage in these populations. Nevertheless, a more simplified means of monitoring therapeutic drugs should be continued, especially for toxic agents.