在接受脏替代疗法的危急病患者中个性化药物剂量的实际考虑
Salmaan Kanji1, Claire Roger2,3, Fabio Silvio Taccone4
1The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Pharmacotherapy
|July 26, 2023
概括
在患有败血症和脏替代疗法 (RRT) 的重症患者中优化抗菌剂量对存活至关重要. 本综述为临床医生提供了当治疗药物监测 (TDM) 不存在时的实际指导.
科学领域:
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
- 腎臟病學 (nephrology) 是一種醫學.
背景情况:
- 败血症和功能障碍在重症监护病房 (ICU) 中很常见.
- 脏替代疗法 (RRT) 常常是严重病情的毒症患者所需的.
- 适当的抗微生物剂量对生存至关重要,但RRT使其复杂化.
研究的目的:
- 审查在接受RRT的重症患者中使用抗微生物剂量的实际考虑.
- 解决在没有常规治疗药物监测 (TDM) 的情况下实现足够的抗微生物药物水平的挑战.
主要方法:
- 重症患者的药理动力学原理和可变性的审查.
- 讨论在RRT期间影响抗菌素处置的因素.
- 对临床,微生物学和药物特异性因素进行分析,以决定剂量.
主要成果:
- 在重症患者中,抗菌素的药理动力学是高度可变的,特别是在RRT患者中.
- RRT方式 (间歇性血液透析,连续或长期间歇) 显著影响药物清除.
- 由于复杂的药物处置,需要个性化剂量策略.
结论:
- 临床医生必须考虑患者的病情,病原体,RRT类型和抗菌剂剂量的药物特性.
- 在没有TDM的情况下,个性化剂量是必不可少的,以确保有效性并避免毒性.
- 本综述为优化这种复杂患者群体的抗微生物治疗提供了实际见解.
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