Pharmacokinetic Alterations Associated with Critical Illness

Area of Science:

• Pharmacology
• Critical Care Medicine
• Clinical Pharmacy

Background:

• Critically ill patients exhibit complex physiological changes affecting drug pharmacokinetics and pharmacodynamics.
• Altered drug protein binding, volume of distribution, and reduced clearance complicate dose optimization.

Purpose of the Study:

• To review alterations in drug pharmacokinetics specific to critical illness.
• To summarize current evidence on managing drug pharmacokinetics in critically ill patients.

Main Methods:

• Literature review of studies on drug pharmacokinetics in critical illness.
• Analysis of factors influencing drug metabolism and excretion in intensive care settings.

Main Results:

• Critical illness impairs oral absorption, hepatic metabolism, and renal clearance.
• Resuscitation strategies and vasoactive drugs can increase drug metabolism and excretion.
• Organ support therapies (e.g., mechanical ventilation, RRT, ECMO) contribute to pharmacokinetic variability.

Conclusions:

• Predicting drug response in critically ill patients is challenging due to competing pharmacokinetic factors.
• Pharmacotherapy guided by therapeutic goals and drug monitoring is crucial for safe patient care.