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Physiologic implications of mechanical ventilation on pharmacokinetics
M W Perkins1, J F Dasta, B DeHaven
1College of Pharmacy, Ohio State University, Columbus 43210.
DICP : the Annals of Pharmacotherapy
|April 1, 1989
Summary
Mechanical ventilation in critically ill patients can decrease drug clearance by affecting blood flow and kidney function. This review explores these pharmacokinetic changes and suggests monitoring drug levels to prevent adverse reactions.
Area of Science:
- Critical Care Medicine
- Pharmacokinetics
- Physiology
Background:
- Critically ill patients often experience decreased drug clearance due to various factors.
- The specific impact of mechanical ventilation on drug clearance remains largely unquantified.
Purpose of the Study:
- To review the physiological effects of mechanical ventilation.
- To propose theoretical pharmacokinetic alterations of drugs used during mechanical ventilation.
Main Methods:
- Review of existing literature on the physiological effects of mechanical ventilation.
- Theoretical pharmacokinetic modeling based on known physiological changes.
Main Results:
- Mechanical ventilation can decrease cardiac output, hepatic and renal blood flow, and glomerular filtration rate.
- These hemodynamic changes theoretically reduce the clearance of renally and hepatically cleared drugs.
- Reduced urine flow may increase tubular reabsorption, further decreasing drug clearance.
Conclusions:
- Mechanical ventilation significantly impacts drug pharmacokinetics in critically ill patients.
- Interventions like volume expansion and inotropic agents may mitigate these effects.
- Monitoring drug serum concentrations is recommended to guide dosing and prevent toxicity.