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Pharmacokinetics of vancomycin during continuous hemodiafiltration
1Intensive Care and Infectious Diseases Unit, Hospital Centre, Tourcoing, France.
Intensive Care Medicine
|January 1, 1993
Summary
Continuous venovenous hemodiafiltration (CVVHD) effectively clears vancomycin in critically ill patients with acute renal failure. Dosing every 12 hours ensures therapeutic vancomycin concentrations during CVVHD.
Area of Science:
- Pharmacokinetics
- Nephrology
- Critical Care Medicine
Background:
- Vancomycin pharmacokinetics are altered in patients with acute renal failure.
- Continuous venovenous hemodiafiltration (CVVHD) is used for renal replacement therapy in critically ill patients.
- Optimizing vancomycin dosing is crucial for effective treatment and minimizing toxicity in this population.
Observation:
- This study investigated vancomycin pharmacokinetics in three patients undergoing CVVHD for acute renal failure.
- Vancomycin was administered intravenously at 7.5 mg/kg, with serial blood and dialysate samples collected.
- Patients were hemodynamically unstable with oligo-anuric acute renal failure.
Findings:
- The mean vancomycin elimination half-life was 13.9 hours.
- Mean total body clearance was 38.9 mL/min, with a dialysate outlet clearance of 4.2 mL/min.
- Peak vancomycin concentrations averaged 27.3 mg/L, with trough concentrations of 3.6 mg/L at 24 hours.
Implications:
- CVVHD demonstrates significant efficacy in eliminating vancomycin.
- A consistent 12-hour dosing interval for vancomycin is recommended to maintain therapeutic levels in patients on CVVHD.
- These findings aid in refining vancomycin dosing strategies for critically ill patients with renal failure undergoing continuous renal replacement therapy.