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Effects of continuous venovenous hemofiltration on vancomycin trough concentrations in critically ill children

Lengyue Peng1, Yawen Gao1, Guangli Zhang1

  • 1Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.

Annals of Translational Medicine
|March 12, 2021
PubMed

Insights

Continuous venovenous hemofiltration (CVVH) in critically ill children may increase vancomycin trough concentrations, leading to supratherapeutic levels. High Pediatric Risk of Mortality (PRISM) III scores are linked to these elevated levels.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacokinetics
  • Nephrology

Background:

  • Vancomycin trough concentrations are crucial for clinical outcomes and minimizing adverse drug effects in critically ill patients.
  • Understanding factors influencing vancomycin levels is essential for optimizing therapy in vulnerable pediatric populations.

Purpose of the Study:

  • To investigate the impact of continuous venovenous hemofiltration (CVVH) on vancomycin trough concentrations in critically ill children.
  • To identify risk factors associated with supratherapeutic vancomycin trough concentrations during CVVH therapy.

Main Methods:

  • Retrospective analysis of critically ill children (January 2016-December 2019) with steady-state vancomycin trough concentrations.
  • Patients were categorized into CVVH and non-CVVH groups based on treatment and renal function.
  • Comparison of vancomycin trough concentrations and logistic regression analysis for risk factors of supratherapeutic levels (>20 mg/L).

Main Results:

  • The CVVH group (n=35) exhibited significantly higher median vancomycin trough concentrations compared to the non-CVVH group (n=84) [14.9 vs. 9.3 mg/L].
  • While therapeutic concentrations (10-20 mg/L) were similar, the CVVH group had a higher proportion of supratherapeutic concentrations (20.0% vs. 1.2%).
  • Pediatric Risk of Mortality (PRISM) III score ≥28 was identified as an independent risk factor for supratherapeutic vancomycin trough concentrations (OR =13.7).

Conclusions:

  • Continuous venovenous hemofiltration (CVVH) therapy significantly influences vancomycin trough concentrations in critically ill children, increasing the risk of supratherapeutic levels with a 40-60 mg/kg/day dosage.
  • Elevated Pediatric Risk of Mortality (PRISM) III scores (≥28) are independently associated with supratherapeutic vancomycin trough concentrations in pediatric patients undergoing CVVH.
Abstract

Keywords:
Vancomycinchildrenconcentrationcontinuous venovenous hemofiltration (CVVH)

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