Continuous Infusion Vancomycin Through the Addition of Vancomycin to the Continuous Renal Replacement Therapy
Jeffrey J Cies1, Wayne S Moore, Susan B Conley
11Center for Pediatric Pharmacotherapy, LLC, Pottstown, PA. 2Department of Pediatrics, Section of Pharmacy, St. Christopher's Hospital for Children, Philadelphia, PA. 3Department of Pediatrics, Section of Pharmacy, Drexel University College of Medicine, Philadelphia, PA. 4Department of Pediatrics, Section of Nephrology, St. Christopher's Hospital for Children, Philadelphia, PA. 5Department of Pediatrics, Section of Nephrology, Drexel University College of Medicine, Philadelphia, PA. 6Department of Pediatrics, Section of Critical Care Medicine, St. Christopher's Hospital for Children, Philadelphia, PA. 7Department of Pediatrics, Section of Critical Care Medicine, Drexel University College of Medicine, Philadelphia, PA. 8Department of Pediatrics, Section of Critical Care Medicine, NYU Langone Medical Center, New York, NY. 9Department of Pediatrics, Section of Critical Care Medicine, NYU School of Medicine, New York, NY.
Insights
Mixing vancomycin into continuous renal replacement therapy (CRRT) solutions effectively achieved therapeutic vancomycin levels in pediatric patients. This method ensured safe and consistent drug delivery during CRRT without adverse events.
Area of Science:
- Pediatric Nephrology
- Pharmacology
- Critical Care Medicine
Background:
- Continuous renal replacement therapy (CRRT) is crucial for pediatric patients with kidney failure.
- Achieving therapeutic drug levels, like vancomycin, during CRRT can be challenging due to altered drug clearance.
- Optimizing vancomycin delivery in critically ill children on CRRT is essential for effective infection management.
Purpose of the Study:
- To evaluate the efficacy of continuous infusion vancomycin administered via CRRT solutions in pediatric patients.
- To determine if mixing vancomycin into CRRT fluids can achieve target serum concentrations.
- To assess the safety of this drug administration method in a pediatric intensive care setting.
Main Methods:
- Retrospective chart review of pediatric patients undergoing CRRT.
- Analysis of vancomycin concentrations in CRRT solutions and corresponding serum levels.
- Inclusion of patients receiving vancomycin mixed directly into their CRRT fluid.
Main Results:
- Eleven out of 21 (52.3%) pediatric patients received vancomycin in their CRRT solution.
- The mean vancomycin plateau level achieved was 22.8 ± 3.3 mg/L.
- All patients attained serum vancomycin levels above 15 mg/L, with no reported adverse events.
Conclusions:
- Adding vancomycin to CRRT solutions is an effective strategy for continuous infusion and achieving therapeutic serum levels in pediatric patients.
- This method facilitates consistent vancomycin delivery during CRRT.
- Further research is needed to explore potential improvements in patient outcomes with this approach.
Objectives:
To describe our experience with achieving therapeutic serum vancomycin concentrations in pediatric continuous renal replacement therapy by using continuous infusion vancomycin by mixing vancomycin into the continuous renal replacement therapy solution.
Design:
Retrospective chart review.
Setting:
A 189-bed, freestanding children's tertiary care teaching hospital in Philadelphia, PA.
Patients:
Pediatric patients receiving continuous renal replacement therapy from April 1, 2009, through December 31, 2014.
Interventions:
None.
Measurements And Main Results:
There were a total of 21 patients who received continuous renal replacement therapy during the study period. Of these, 11 (52.3%) received vancomycin in the continuous renal replacement therapy solution. The median (range) concentration of vancomycin added to the continuous renal replacement therapy solution was 25 mg/L (18-35 mg/L). The mean vancomycin plateau level was 22.8 ± 3.3 mg/L. All patients achieved a serum vancomycin plateau level that was greater than 15 mg/L. There were no adverse events related to the addition of vancomycin to the continuous renal replacement therapy solution.
Conclusions:
The addition of vancomycin to the continuous renal replacement therapy solution(s) is an effective modality that is used for delivering vancomycin continuous infusion and for ensuring therapeutic vancomycin serum plateau levels in the setting of pediatric continuous renal replacement therapy. Further studies are required to evaluate whether this delivery method can lead to improved patient outcomes.
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