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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
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Measuring antibiotics in exhaled air in critically ill, non-ventilated patients: A feasibility and proof of concept

J Herregodts1, S Van Vooren1, E Deschuyteneer2

  • 1Ghent University, Department of Diagnostic Sciences, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University Hospital, Department of Laboratory Medicine, C. Heymanslaan 10, 9000 Ghent, Belgium.

Journal of Critical Care
|February 13, 2019
PubMed
Abstract

Insights

Antibiotics like piperacillin and meropenem can be detected in the exhaled air of intensive care unit patients. However, these levels in breath did not correlate with drug concentrations in the blood plasma.

Area of Science:

  • Pharmacokinetics
  • Clinical Chemistry
  • Respiratory Medicine

Background:

  • Optimizing antibiotic therapy often involves measuring drug concentrations.
  • Plasma is the standard matrix for antibiotic level monitoring.
  • Exhaled air presents a potential alternative matrix for antibiotic analysis.

Purpose of the Study:

  • To investigate the feasibility of detecting and quantifying piperacillin and meropenem in exhaled air.
  • To compare antibiotic concentrations in exhaled air with those in plasma.

Main Methods:

  • Studied 11 spontaneously breathing ICU patients receiving piperacillin/tazobactam or meropenem.
  • Collected exhaled air using the ExaBreath® device for antibiotic extraction.
  • Measured antibiotic presence in device condensate and simultaneously in patient plasma.

Main Results:

  • Piperacillin and meropenem were detected in the exhaled air filter of 9 patients and condensate of 10.
  • Quantities in exhaled air varied significantly, with no correlation to plasma concentrations.
  • Meropenem in condensate was below the limit of quantification in some cases.

Conclusions:

  • Piperacillin and meropenem can be detected and quantified in the exhaled air of non-ventilated ICU patients.
  • Exhaled air antibiotic levels did not correlate with plasma concentrations in this study.
  • Exhaled air monitoring may offer a novel approach, but requires further investigation for therapeutic drug monitoring.
Keywords:
Beta-lactam antibioticsExhaled breathSensAbuesTherapeutic drug monitoringUHPLC-HR-MS

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