蒙特卡洛模拟Cefepime在接受连续脏替代疗法的儿童中,支持连续输注以实现目标
H Rhodes Hambrick1,2,3,4, Nieko Punt5,6, Kathryn Pavia7,8,9
1Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center (CCHMC), 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. hhambrick@luriechildrens.org.
Journal of intensive care
|October 8, 2024
概括
连续输注塞菲皮姆 (CI) 在接受连续脏替代疗法 (CKRT) 的儿科患者中实现目标 (PTA) 的概率更高. 剂量策略必须考虑CKRT强度和残留功能,以在重症儿童中获得最佳的Cefepime治疗.
科学领域:
- 药理动力学和药理动力学
- 儿科重症监护中心儿童重症监护中心
- 腎臟病學 (nephrology) 是一種醫學.
背景情况:
- 败血症经常导致急性损伤 (AKI),需要持续的置换疗法 (CKRT).
- 持续置换疗法 (CKRT) 显著影响药物药理动力学 (PK),包括cefepime.
- 关于在接受CKRT的儿科患者中实现cefepime PK和药理动力学 (PD) 目标的数据有限.
研究的目的:
- 用蒙特卡洛模拟 (MCS) 来评估在接受CKRT的儿科患者中cefepime的剂量策略.
- 为了确定在不同的CKRT条件下不同cefepime剂量方案实现目标 (PTA) 的概率.
主要方法:
- 一个新的CKRT模块被集成到Edsim++软件和一个儿科cefepime PK模型中.
- 对儿科患者 (2-25岁,≥10公斤) 进行了一千倍的蒙特卡洛模拟 (MCS).
- 模拟包括不同的残留功能 (eGFR 5 vs 30 mL/min/1.73 m2),CKRT废水流量 (2500 vs 8000 mL/h/1.73 m2) 和液体积累 (0-30%).
主要成果:
- 100-150毫克/公斤/天的连续输注 (CI) 和50毫克/公斤的4小时输注,在标准剂量CKRT下达到90%以上的PTA,100%的FT>1倍MIC,功能最小.
- 达到>90%的PTA100%的FT>4倍的MIC需要150 mg/kg的CI.
- 观察到PTA降低与较少的剂量,更短的输液,更高剂量的CKRT,和更大的残留功能.
结论:
- 开发的CKRT模块在CKRT的儿科患者中成功模拟了cefepime PK和PTA.
- 持续输注 (CI) 的cefepime优于间歇剂量达到更高的PTA,特别是当目标100% fT>4xMIC或使用高剂量的CKRT.
- 优化塞费皮姆剂量策略对于治疗重症儿童 AKI 需要 CKRT 的有效治疗至关重要.
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