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Crrt, drug dosing

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https://www.readbyqxmd.com/read/28458893/successful-treatment-of-thyroid-storm-presenting-as-recurrent-cardiac-arrest-and-subsequent-multiorgan-failure-by-continuous-renal-replacement-therapy
#1
Han Soo Park, Su Kyoung Kwon, Ye Na Kim
SUMMARY: Thyroid storm is a rare and potentially life-threatening medical emergency. We experienced a case of thyroid storm associated with sepsis caused by pneumonia, which had a catastrophic course including recurrent cardiac arrest and subsequent multiple organ failure (MOF). A 22-year-old female patient with a 10-year history of Graves' disease was transferred to our emergency department (ED). She had a cardiac arrest at her home and a second cardiac arrest at the ED. Her heart recovered after 20 min of cardiac resuscitation...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/28395664/the-future-of-critical-care-renal-support-in-2027
#2
REVIEW
William R Clark, Mauro Neri, Francesco Garzotto, Zaccaria Ricci, Stuart L Goldstein, Xiaoqiang Ding, Jiarui Xu, Claudio Ronco
Since its inception four decades ago, both the clinical and technologic aspects of continuous renal replacement therapy (CRRT) have evolved substantially. Devices now specifically designed for critically ill patients with acute kidney injury are widely available and the clinical challenges associated with treating this complex patient population continue to be addressed. However, several important questions remain unanswered, leaving doubts in the minds of many clinicians about therapy prescription/delivery and patient management...
April 11, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28341612/impact-of-%C3%AE-lactam-antibiotic-therapeutic-drug-monitoring-on-dose-adjustments-in-critically-ill-patients-undergoing-continuous-renal-replacement-therapy
#3
Caleb J P Economou, Gloria Wong, Brett McWhinney, Jacobus P J Ungerer, Jeffrey Lipman, Jason A Roberts
The objective of this study was to describe the effect of therapeutic drug monitoring (TDM) and dose adjustments of β-lactam antibiotics administered to critically ill patients undergoing continuous renal replacement therapy (CRRT) in a 30-bed tertiary intensive care unit (ICU). β-Lactam TDM data in our tertiary referral ICU were retrospectively reviewed. Clinical, demographic and dosing data were collected for patients administered β-lactam antibiotics while undergoing CRRT. The target trough concentration range was 1-10× the minimum inhibitory concentration (MIC)...
March 21, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28337084/therapeutic-drug-monitoring-of-continuous-infusion-doripenem-in-a-pediatric-patient-on-continuous-renal-replacement-therapy
#4
Jeffrey J Cies, Wayne S Moore, Susan B Conley, Paul Shea, Adela Enache, Arun Chopra
An 11-year-old African American male with severe combined immunodeficiency variant, non-cystic fibrosis bronchiectasis, pancreatic insufficiency, chronic mycobacterium avium-intracellulare infection, chronic sinusitis, and malnutrition presented with a 1-week history of fevers. He subsequently developed respiratory decompensation and cefepime was discontinued and doripenem was initiated. Doripenem was the carbapenem used due to a national shortage of meropenem. By day 7 the patient (24.7 kg) had a positive fluid balance of 6925 mL (28% FO), and on days 7 into 8 developed acute kidney injury evidenced by an elevated serum creatinine of 0...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28337082/pharmacokinetics-of-peramivir-in-an-adolescent-patient-receiving-continuous-venovenous-hemodiafiltration
#5
Ryan C Dillon, Robert Witcher, Jeffrey J Cies, Wayne S Moore, Arun Chopra
Critically ill patients requiring renal replacement therapy commonly experience pharmacokinetic alterations. This case report describes the pharmacokinetics of peramivir (Rapivab, BioCryst Pharmaceuticals, Inc, Durham, NC), the first US Food and Drug Administration-approved intravenous neuraminidase inhibitor for the treatment of influenza, in an adolescent patient receiving continuous renal replacement therapy (CRRT). A 49.5-kg, 17-year-old Caucasian female presented with fever, cough, and persistent hypoxia...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28254856/considerations-for-medication-management-and-anticoagulation-during-continuous-renal-replacement-therapy
#6
Ashley Thompson, Fanny Li, A Kendall Gross
Providing safe and high-quality care to critically ill patients receiving continuous renal replacement therapy (CRRT) includes adequate drug dosing and evaluation of patients' response to medications during therapy. Pharmacokinetic drug studies in acute kidney injury and CRRT are limited, considering the number of medications used in critical care. Therefore, it is important to understand the basic principles of drug clearance during CRRT by evaluating drug properties, CRRT modalities, and how they affect medication clearance...
2017: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/28035589/caspofungin-population-pharmacokinetics-in-critically-ill-patients-undergoing-continuous-veno-venous-haemofiltration-or-haemodiafiltration
#7
Claire Roger, Steven C Wallis, Laurent Muller, Gilbert Saissi, Jeffrey Lipman, Roger J Brüggemann, Jean-Yves Lefrant, Jason A Roberts
BACKGROUND AND OBJECTIVE: Sepsis and continuous renal replacement therapy (CRRT) can both significantly affect antifungal pharmacokinetics. This study aimed to describe the pharmacokinetics of caspofungin in critically ill patients during different CRRT modes. METHODS: Patients receiving caspofungin and undergoing continuous veno-venous haemofiltration (CVVH) or haemodiafiltration (CVVHDF) were eligible to take part in the study. Blood samples were collected at seven sampling times during a dosing interval...
December 29, 2016: Clinical Pharmacokinetics
https://www.readbyqxmd.com/read/27862103/pharmacokinetics-of-imipenem-cilastatin-burn-intensive-care-unit-patients-undergoing-high-dose-continuous-venovenous-hemofiltration
#8
Bradley A Boucher, Joanna Q Hudson, David M Hill, Joseph M Swanson, G Christopher Wood, S Casey Laizure, Angela Arnold-Ross, Zhe-Yi Hu, William L Hickerson
STUDY OBJECTIVE: High-dose continuous venovenous hemofiltration (CVVH) is a continuous renal replacement therapy (CRRT) used frequently in patients with burns. However, antibiotic dosing is based on inference from studies assessing substantially different methods of CRRT. To address this knowledge gap for imipenem/cilastatin (I/C), we evaluated the systemic and extracorporeal clearances (CLs) of I/C in patients with burns undergoing high-dose CVVH. DESIGN: Prospective clinical pharmacokinetic study...
December 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27628437/population-pharmacokinetics-of-daptomycin-in-adult-patients-undergoing-continuous-renal-replacement-therapy
#9
Xiaoying Xu, Dmytro Khadzhynov, Harm Peters, Ricardo L Chaves, Kamal Hamed, Micha Levi, Natascia Corti
AIM: The objective of this population pharmacokinetic (PK) analysis was to provide guidance for the dosing interval of daptomycin in patients undergoing continuous renal replacement therapy (CRRT). METHODS: A previously published population PK model for daptomycin was updated with data from patients undergoing continuous veno-venous haemodialysis (CVVHD; n = 9) and continuous veno-venous haemodiafiltration (CVVHDF; n = 8). Model-based simulations were performed to compare the 24 h AUC, Cmax and Cmin of daptomycin following various dosing regimens (4, 6, 8, 10, and 12 mg kg(-1) every [Q] 24 h and Q48 h), with the safety and efficacy exposure references for Staphylococcus aureus bacteraemia/right-sided infective endocarditis...
March 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/27587068/antiepileptic-drug-removal-by-continuous-renal-replacement-therapy-a-review-of-the-literature
#10
REVIEW
Sherif Hanafy Mahmoud
Continuous renal replacement therapy (CRRT) is used for managing acute kidney injury in critically ill patients. Removal of antiepileptic drugs (AEDs) by CRRT could be significant and may complicate patients' intensive care unit stay. The objective of the current review was to summarize the available evidence for AED removal by CRRT. An electronic literature search of PubMed (1946 to May 2016), Medline (1946 to May 2016), and Embase (1974 to May 2016) databases for studies discussing AED removal by CRRT was conducted...
January 2017: Clinical Drug Investigation
https://www.readbyqxmd.com/read/27433357/antimicrobial-doses-in-continuous-renal-replacement-therapy-a-comparison-of-dosing-strategies
#11
Anna P Kempke, Abbie S Leino, Farzad Daneshvar, John Andrew Lee, Bruce A Mueller
Purpose. Drug dose recommendations are not well defined in patients undergoing continuous renal replacement therapy (CRRT) due to limited published data. Several guidelines and pharmacokinetic equations have been proposed as tools for CRRT drug dosing. Dose recommendations derived from these methods have yet to be compared or prospectively evaluated. Methods. A literature search of PubMed, Micromedex, and Embase was conducted for 40 drugs commonly used in the ICU to gather pharmacokinetic data acquired from patients with acute and chronic kidney disease as well as healthy volunteers...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27270279/influence-of-renal-replacement-modalities-on-amikacin-population-pharmacokinetics-in-critically-ill-patients-on-continuous-renal-replacement-therapy
#12
Claire Roger, Steven C Wallis, Laurent Muller, Gilbert Saissi, Jeffrey Lipman, Jean-Yves Lefrant, Jason A Roberts
The objective of this study was to describe amikacin pharmacokinetics (PK) in critically ill patients receiving equal doses (30 ml/kg of body weight/h) of continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodiafiltration (CVVHDF). Patients receiving amikacin and undergoing CVVH or CVVHDF were eligible. Population pharmacokinetic analysis and Monte Carlo simulation were undertaken using the Pmetrics software package for R. Sixteen patients (9 undergoing CVVH, 11 undergoing CVVHDF) and 20 sampling intervals were analyzed...
August 2016: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/27082510/we-underdose-antibiotics-in-patients-on-crrt
#13
Alexander R Shaw, Weerachai Chaijamorn, Bruce A Mueller
Appropriate antibiotic dosing in critically ill, infected, patients receiving continuous renal replacement therapy (CRRT) is crucial to improve patient outcomes. Severe sepsis and septic shock result in changes in pharmacokinetic parameters, including increased volume of distribution, hypoalbuminemia, and changes in renal and nonrenal clearances. The lack of CRRT standardization, nonrecognition of how CRRT variability affects antibiotic removal, fear of antibiotic toxicity, and limited drug dosing resources all contribute to suboptimal antibiotic therapy...
July 2016: Seminars in Dialysis
https://www.readbyqxmd.com/read/27012450/ceftolozane-tazobactam-pharmacokinetics-in-a-critically-ill-adult-receiving-continuous-renal-replacement-therapy
#14
Derek N Bremmer, David P Nicolau, Pam Burcham, Anil Chunduri, Ganesh Shidham, Karri A Bauer
Limited data are available on ceftolozane/tazobactam dosing in patients receiving continuous renal replacement therapy (CRRT). Thus we performed a pharmacokinetic analysis of intravenous ceftolozane/tazobactam in a critically ill patient receiving CRRT at our medical center. A 47-year-old critically ill man with multidrug-resistant Pseudomonas aeruginosa pneumonia, bacteremia, and osteomyelitis was receiving ceftolozane/tazobactam 3 g (ceftolozane 2 g/tazobactam 1 g) every 8 hours while receiving continuous venovenous hemodiafiltration (CVVHDF)...
May 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/26719674/association-of-systolic-blood-pressure-drop-with-intravenous-administration-of-itraconazole-in-children-with-hemato-oncologic-disease
#15
Hyeong Jin Lee, Bongjin Lee, June Dong Park, Hyung Joo Jeong, Yu Hyeon Choi, Hee Young Ju, Che Ry Hong, Ji Won Lee, Hyery Kim, Dong In Suh, Kyung Duk Park, Hyoung Jin Kang, Hee Young Shin, Hyo Seop Ahn
PURPOSE: Although few adverse effects have been reported for itraconazole, a widely used antifungal therapy for febrile neutropenia, we found intravenous (IV) itraconazole to be associated with serious cases of blood pressure (BP) drop. We therefore evaluated the incidence and risk factors for BP drop during IV administration of the drug. MATERIALS AND METHODS: We reviewed the medical records of children with hemato-oncologic disease who were treated with IV itraconazole from January 2012 to December 2013...
2015: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/26709896/drug-dosage-in-continuous-venoveno-hemofiltration-in-critically-ill-children
#16
REVIEW
Farahnak Assadi, Fatemeh Ghane Shahrbaf
The dosage of drugs in patients requiring continuous renal replacement therapy need to be adjusted based on a number of variables that that affect pharmacokinetics (PK) including patient weight, CRRT modality (convention, vs. diffusion), blood and/or effluent flow, hemofilter characteristics, physiochemical drug properties, volume of distribution, protein binding and half-life as well as residual renal function. There is a paucity of data on PK studies in children with acute kidney injury requiring CRRT. When possible, therapeutic drug monitoring should be utilized for those medications where serum drug concentrations can be obtained in a clinically relevant time frame...
2016: Frontiers in Bioscience (Scholar Edition)
https://www.readbyqxmd.com/read/26667969/to-increase-or-decrease-dosage-of-antimicrobials-in-septic-patients-during-continuous-renal-replacement-therapy-the-eternal-doubt
#17
REVIEW
Wai-Tat Wong, Gordon Choi, Charles D Gomersall, Jeffrey Lipman
Critical illness, acute renal failure and continuous renal replacement therapy (CRRT) are associated with changes in pharmacokinetics. Initial antibiotic dose should be based on published volume of distribution and generally be at least the standard dose, as volume of distribution is usually unchanged or increased. Subsequent doses should be based on total clearance. Total clearance varies with the CRRT clearance which mainly depends on effluent flow rate, sieving coefficient/saturation coefficient. As antibiotic clearance by healthy kidneys is usually higher than clearance by CRRT, except for colistin, subsequent doses should generally be lower than given to patients without renal dysfunction...
October 2015: Current Opinion in Pharmacology
https://www.readbyqxmd.com/read/26543849/early-fluid-resuscitation-and-high-volume-hemofiltration-decrease-septic-shock-progression-in-swine
#18
Ping Zhao, Ruiqiang Zheng, Lu Xue, Min Zhang, Xiaoyan Wu
This study aimed to assess the effects of early fluid resuscitation (EFR) combined with high volume hemofiltration (HVHF) on the cardiopulmonary function and removal of inflammatory mediators in a septic shock swine model. Eighteen swine were randomized into three groups: control (n = 6) (extracorporeal circulating blood only), continuous renal replacement therapy (CRRT) (n = 6; ultrafiltration volume = 25 mL/Kg/h), and HVHF (n = 6; ultrafiltration volume = 85 mL/Kg/h). The septic shock model was established by intravenous infusion of lipopolysaccharides (50 µg/kg/h)...
2015: BioMed Research International
https://www.readbyqxmd.com/read/26246919/flucytosine-pharmacokinetics-in-a-critically-ill-patient-receiving-continuous-renal-replacement-therapy
#19
Megan E Kunka, Elizabeth A Cady, Heejung C Woo, Melissa L Thompson Bastin
Purpose. A case report evaluating flucytosine dosing in a critically ill patient receiving continuous renal replacement therapy. Summary. This case report outlines an 81-year-old male who was receiving continuous venovenous hemofiltration (CVVH) for acute renal failure and was being treated with flucytosine for the treatment of disseminated Cryptococcus neoformans infection. Due to patient specific factors, flucytosine was empirically dose adjusted approximately 50% lower than intermittent hemodialysis (iHD) recommendations and approximately 33% lower than CRRT recommendations...
2015: Case Reports in Critical Care
https://www.readbyqxmd.com/read/26124172/meropenem-population-pharmacokinetics-in-critically-ill-patients-with-septic-shock-and-continuous-renal-replacement-therapy-influence-of-residual-diuresis-on-dose-requirements
#20
Marta Ulldemolins, Dolors Soy, Mireia Llaurado-Serra, Sergi Vaquer, Pedro Castro, Alejandro H Rodríguez, Caridad Pontes, Gonzalo Calvo, Antoni Torres, Ignacio Martín-Loeches
Meropenem dosing in critically ill patients with septic shock and continuous renal replacement therapy (CRRT) is complex, with the recommended maintenance doses being 500 mg to 1,000 mg every 8 h (q8h) to every 12 h. This multicenter study aimed to describe the pharmacokinetics (PKs) of meropenem in this population to identify the sources of PK variability and to evaluate different dosing regimens to develop recommendations based on clinical parameters. Thirty patients with septic shock and CRRT receiving meropenem were enrolled (153 plasma samples were tested)...
September 2015: Antimicrobial Agents and Chemotherapy
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