You searched for:"Arnaldo Dubin"
We found (12) results for your search.-
Original Article
Lack of change in the respiratory quotient during oxygen supply dependence in endotoxemic shock: a subanalysis of an experimental controlled study
- Arnaldo Dubin
, - Juan Francisco Caminos Eguillor ,
- Gonzalo Ferrara ,
- María Guillermina Buscetti ,
- Héctor Saúl Canales , [ … ],
- Vanina Siham Kanoore Edul
Abstract
Original ArticleLack of change in the respiratory quotient during oxygen supply dependence in endotoxemic shock: a subanalysis of an experimental controlled study
Crit Care Sci. 2023;35(3):281-289
DOI 10.5935/2965-2774.20230041-pt
- Arnaldo Dubin ,
- Juan Francisco Caminos Eguillor ,
- Gonzalo Ferrara ,
- María Guillermina Buscetti ,
- Héctor Saúl Canales ,
- Bernardo Lattanzio ,
- Luis Gatti ,
- Facundo Javier Gutierrez ,
- Vanina Siham Kanoore Edul
Views5See moreABSTRACT
Objective:
To evaluate if the reductions in systemic and renal oxygen consumption are associated with the development of evidence of anaerobic metabolism.
Methods:
This is a subanalysis of a previously published study. In anesthetized and mechanically ventilated sheep, we measured the respiratory quotient by indirect calorimetry and its systemic, renal, and intestinal surrogates (the ratios of the venous-arterial carbon dioxide pressure and content difference to the arterial-venous oxygen content difference. The Endotoxemic Shock Group (n = 12) was measured at baseline, after 60 minutes of endotoxemic shock, and after 60 and 120 minutes of fluid and norepinephrine resuscitation, and the values were compared with those of a Control Group (n = 12) without interventions.
Results:
Endotoxemic shock decreased systemic and renal oxygen consumption (6.3 [5.6 – 6.6] versus 7.4 [6.3 – 8.5] mL/minute/kg and 3.7 [3.3 – 4.5] versus 5.4 [4.6 – 9.4] mL/minute/100g; p < 0.05 for both). After 120 minutes of resuscitation, systemic oxygen consumption was normalized, but renal oxygen consumption remained decreased (6.3 [5.9 - 8.2] versus 7.1 [6.1 – 8.6] mL/minute/100g; p = not significance and 3.8 [1.9 – 4.8] versus 5.7 [4.5 – 7.1]; p < 0.05). The respiratory quotient and the systemic, renal and intestinal ratios of the venous-arterial carbon dioxide pressure and content difference to the arterial-venous oxygen content difference did not change throughout the experiments.
Conclusion:
In this experimental model of septic shock, oxygen supply dependence was not associated with increases in the respiratory quotient or its surrogates. Putative explanations for these findings are the absence of anaerobic metabolism or the poor sensitivity of these variables in detecting this condition.
Views5
Abstract
Original ArticleLack of change in the respiratory quotient during oxygen supply dependence in endotoxemic shock: a subanalysis of an experimental controlled study
Crit Care Sci. 2023;35(3):281-289
DOI 10.5935/2965-2774.20230041-pt
- Arnaldo Dubin ,
- Juan Francisco Caminos Eguillor ,
- Gonzalo Ferrara ,
- María Guillermina Buscetti ,
- Héctor Saúl Canales ,
- Bernardo Lattanzio ,
- Luis Gatti ,
- Facundo Javier Gutierrez ,
- Vanina Siham Kanoore Edul
Views5See moreABSTRACT
Objective:
To evaluate if the reductions in systemic and renal oxygen consumption are associated with the development of evidence of anaerobic metabolism.
Methods:
This is a subanalysis of a previously published study. In anesthetized and mechanically ventilated sheep, we measured the respiratory quotient by indirect calorimetry and its systemic, renal, and intestinal surrogates (the ratios of the venous-arterial carbon dioxide pressure and content difference to the arterial-venous oxygen content difference. The Endotoxemic Shock Group (n = 12) was measured at baseline, after 60 minutes of endotoxemic shock, and after 60 and 120 minutes of fluid and norepinephrine resuscitation, and the values were compared with those of a Control Group (n = 12) without interventions.
Results:
Endotoxemic shock decreased systemic and renal oxygen consumption (6.3 [5.6 – 6.6] versus 7.4 [6.3 – 8.5] mL/minute/kg and 3.7 [3.3 – 4.5] versus 5.4 [4.6 – 9.4] mL/minute/100g; p < 0.05 for both). After 120 minutes of resuscitation, systemic oxygen consumption was normalized, but renal oxygen consumption remained decreased (6.3 [5.9 - 8.2] versus 7.1 [6.1 – 8.6] mL/minute/100g; p = not significance and 3.8 [1.9 – 4.8] versus 5.7 [4.5 – 7.1]; p < 0.05). The respiratory quotient and the systemic, renal and intestinal ratios of the venous-arterial carbon dioxide pressure and content difference to the arterial-venous oxygen content difference did not change throughout the experiments.
Conclusion:
In this experimental model of septic shock, oxygen supply dependence was not associated with increases in the respiratory quotient or its surrogates. Putative explanations for these findings are the absence of anaerobic metabolism or the poor sensitivity of these variables in detecting this condition.
- Arnaldo Dubin
-
Editorial
The relationship of postocclusive reactive hyperemia assessed by the plethysmographic perfusion index to lactate clearance: a new piece in the unsolved puzzle of tissue perfusion and oxygenation in septic shock
Crit Care Sci. 2023;35(2):115-116
Abstract
EditorialThe relationship of postocclusive reactive hyperemia assessed by the plethysmographic perfusion index to lactate clearance: a new piece in the unsolved puzzle of tissue perfusion and oxygenation in septic shock
Crit Care Sci. 2023;35(2):115-116
DOI 10.5935/2965-2774.2023.Edit-2.v35n2-pt
Views5Septic shock is commonly characterized by the lack of coherence between systemic hemodynamics and microcirculation.() The optimization of systemic cardiovascular variables frequently fails to improve the outcome of septic patients. Since the final goal of resuscitation should be the normalization of tissue perfusion and oxygenation, there is a growing interest in the monitoring of microvascular […]See moreViews5Abstract
EditorialThe relationship of postocclusive reactive hyperemia assessed by the plethysmographic perfusion index to lactate clearance: a new piece in the unsolved puzzle of tissue perfusion and oxygenation in septic shock
Crit Care Sci. 2023;35(2):115-116
DOI 10.5935/2965-2774.2023.Edit-2.v35n2-pt
Views5Septic shock is commonly characterized by the lack of coherence between systemic hemodynamics and microcirculation.() The optimization of systemic cardiovascular variables frequently fails to improve the outcome of septic patients. Since the final goal of resuscitation should be the normalization of tissue perfusion and oxygenation, there is a growing interest in the monitoring of microvascular […]See more -
Review Article
Comparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis
- Arnaldo Dubin ,
- Cecilia Inés Loudet ,
- Francisco Javier Hurtado ,
- Mario Omar Pozo ,
- Daniel Comande , [ … ],
- Ariel Bardach
Abstract
Review ArticleComparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis
Rev Bras Ter Intensiva. 2022;34(2):279-286
DOI 10.5935/0103-507X.20220026-en
- Arnaldo Dubin ,
- Cecilia Inés Loudet ,
- Francisco Javier Hurtado ,
- Mario Omar Pozo ,
- Daniel Comande ,
- Luz Gibbons ,
- Federico Rodriguez Cairoli ,
- Ariel Bardach
Views1See moreABSTRACT
Objective:
The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting Pcv-aCO2/Ca-cvO2 as a predictor of mortality in critically ill patients compared with lactate.
Methods:
We searched several databases for studies measuring Pcv-aCO2/Ca-cvO2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of Pcv-aCO2/Ca-cvO2 and lactate.
Results:
We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean Pcv-aCO2/Ca-cvO2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 – 1.17; I = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 – 1.54; I = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them.
Conclusion:
Moderate-quality evidence showed little or no difference in the ability of Pcv-aCO2/Ca-cvO2, compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies.
Views1Abstract
Review ArticleComparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis
Rev Bras Ter Intensiva. 2022;34(2):279-286
DOI 10.5935/0103-507X.20220026-en
- Arnaldo Dubin ,
- Cecilia Inés Loudet ,
- Francisco Javier Hurtado ,
- Mario Omar Pozo ,
- Daniel Comande ,
- Luz Gibbons ,
- Federico Rodriguez Cairoli ,
- Ariel Bardach
Views1See moreABSTRACT
Objective:
The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting Pcv-aCO2/Ca-cvO2 as a predictor of mortality in critically ill patients compared with lactate.
Methods:
We searched several databases for studies measuring Pcv-aCO2/Ca-cvO2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of Pcv-aCO2/Ca-cvO2 and lactate.
Results:
We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean Pcv-aCO2/Ca-cvO2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 – 1.17; I = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 – 1.54; I = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them.
Conclusion:
Moderate-quality evidence showed little or no difference in the ability of Pcv-aCO2/Ca-cvO2, compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies.
- Arnaldo Dubin
-
Review Article
Central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio as an indicator of tissue oxygenation: a narrative review
Rev Bras Ter Intensiva. 2020;32(1):115-122
Abstract
Review ArticleCentral venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio as an indicator of tissue oxygenation: a narrative review
Rev Bras Ter Intensiva. 2020;32(1):115-122
DOI 10.5935/0103-507X.20200017
Views0See moreABSTRACT
The central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) has been proposed as a surrogate for respiratory quotient and an indicator of tissue oxygenation. Some small observational studies have found that a Pcv-aCO2/Ca-cvO2 > 1.4 was associated with hyperlactatemia, oxygen supply dependency, and increased mortality. Moreover, Pcv-aCO2/Ca-cvO2 has been incorporated into algorithms for tissue oxygenation evaluation and resuscitation. However, the evidence for these recommendations is quite limited and of low quality. The goal of this narrative review was to analyze the methodological bases, the pathophysiologic foundations, and the experimental and clinical evidence supporting the use of Pcv-aCO2/Ca-cvO2 as a surrogate for respiratory quotient. Physiologically, the increase in respiratory quotient secondary to critical reductions in oxygen transport is a life-threatening and dramatic event. Nevertheless, this event is easily noticeable and probably does not require further monitoring. Since the beginning of anaerobic metabolism is indicated by the sudden increase in respiratory quotient and the normal range of respiratory quotient is wide, the use of a defined cutoff of 1.4 for Pcv-aCO2/Ca-cvO2 is meaningless. Experimental studies have shown that Pcv-aCO2/Ca-cvO2 is more dependent on factors that modify the dissociation of carbon dioxide from hemoglobin than on respiratory quotient and that respiratory quotient and Pcv-aCO2/Ca-cvO2 may have distinct behaviors. Studies performed in critically ill patients have shown controversial results regarding the ability of Pcv-aCO2/Ca-cvO2 to predict outcome, hyperlactatemia, microvascular abnormalities, and oxygen supply dependency. A randomized controlled trial also showed that Pcv-aCO2/Ca-cvO2 is useless as a goal of resuscitation. Pcv-aCO2/Ca-cvO2 should be carefully interpreted in critically ill patients.
Views0Abstract
Review ArticleCentral venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio as an indicator of tissue oxygenation: a narrative review
Rev Bras Ter Intensiva. 2020;32(1):115-122
DOI 10.5935/0103-507X.20200017
Views0See moreABSTRACT
The central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) has been proposed as a surrogate for respiratory quotient and an indicator of tissue oxygenation. Some small observational studies have found that a Pcv-aCO2/Ca-cvO2 > 1.4 was associated with hyperlactatemia, oxygen supply dependency, and increased mortality. Moreover, Pcv-aCO2/Ca-cvO2 has been incorporated into algorithms for tissue oxygenation evaluation and resuscitation. However, the evidence for these recommendations is quite limited and of low quality. The goal of this narrative review was to analyze the methodological bases, the pathophysiologic foundations, and the experimental and clinical evidence supporting the use of Pcv-aCO2/Ca-cvO2 as a surrogate for respiratory quotient. Physiologically, the increase in respiratory quotient secondary to critical reductions in oxygen transport is a life-threatening and dramatic event. Nevertheless, this event is easily noticeable and probably does not require further monitoring. Since the beginning of anaerobic metabolism is indicated by the sudden increase in respiratory quotient and the normal range of respiratory quotient is wide, the use of a defined cutoff of 1.4 for Pcv-aCO2/Ca-cvO2 is meaningless. Experimental studies have shown that Pcv-aCO2/Ca-cvO2 is more dependent on factors that modify the dissociation of carbon dioxide from hemoglobin than on respiratory quotient and that respiratory quotient and Pcv-aCO2/Ca-cvO2 may have distinct behaviors. Studies performed in critically ill patients have shown controversial results regarding the ability of Pcv-aCO2/Ca-cvO2 to predict outcome, hyperlactatemia, microvascular abnormalities, and oxygen supply dependency. A randomized controlled trial also showed that Pcv-aCO2/Ca-cvO2 is useless as a goal of resuscitation. Pcv-aCO2/Ca-cvO2 should be carefully interpreted in critically ill patients.
-
Original Article
Statistical analysis plan for early goal-directed therapy using a physiological holistic view – the ANDROMEDA-SHOCK: a randomized controlled trial
Rev Bras Ter Intensiva. 2018;30(3):253-263
Abstract
Original ArticleStatistical analysis plan for early goal-directed therapy using a physiological holistic view – the ANDROMEDA-SHOCK: a randomized controlled trial
Rev Bras Ter Intensiva. 2018;30(3):253-263
DOI 10.5935/0103-507X.20180041
Views0See moreABSTRACT
Background:
ANDROMEDA-SHOCK is an international, multicenter, randomized controlled trial comparing peripheral perfusion-targeted resuscitation to lactate-targeted resuscitation in patients with septic shock in order to test the hypothesis that resuscitation targeting peripheral perfusion will be associated with lower morbidity and mortality.
Objective:
To report the statistical analysis plan for the ANDROMEDA-SHOCK trial.
Methods:
We describe the trial design, primary and secondary objectives, patients, methods of randomization, interventions, outcomes, and sample size. We describe our planned statistical analysis for the primary, secondary and tertiary outcomes. We also describe the subgroup and sensitivity analyses. Finally, we provide details for presenting our results, including mock tables showing baseline characteristics, the evolution of hemodynamic and perfusion variables, and the effects of treatments on outcomes.
Conclusion:
According to the best trial practice, we report our statistical analysis plan and data management plan prior to locking the database and initiating the analyses. We anticipate that this procedure will prevent analysis bias and enhance the utility of the reported results.
Views0Abstract
Original ArticleStatistical analysis plan for early goal-directed therapy using a physiological holistic view – the ANDROMEDA-SHOCK: a randomized controlled trial
Rev Bras Ter Intensiva. 2018;30(3):253-263
DOI 10.5935/0103-507X.20180041
Views0See moreABSTRACT
Background:
ANDROMEDA-SHOCK is an international, multicenter, randomized controlled trial comparing peripheral perfusion-targeted resuscitation to lactate-targeted resuscitation in patients with septic shock in order to test the hypothesis that resuscitation targeting peripheral perfusion will be associated with lower morbidity and mortality.
Objective:
To report the statistical analysis plan for the ANDROMEDA-SHOCK trial.
Methods:
We describe the trial design, primary and secondary objectives, patients, methods of randomization, interventions, outcomes, and sample size. We describe our planned statistical analysis for the primary, secondary and tertiary outcomes. We also describe the subgroup and sensitivity analyses. Finally, we provide details for presenting our results, including mock tables showing baseline characteristics, the evolution of hemodynamic and perfusion variables, and the effects of treatments on outcomes.
Conclusion:
According to the best trial practice, we report our statistical analysis plan and data management plan prior to locking the database and initiating the analyses. We anticipate that this procedure will prevent analysis bias and enhance the utility of the reported results.
-
Review Articles
The spectrum of cardiovascular effects of dobutamine – from healthy subjects to septic shock patients
Rev Bras Ter Intensiva. 2017;29(4):490-498
Abstract
Review ArticlesThe spectrum of cardiovascular effects of dobutamine – from healthy subjects to septic shock patients
Rev Bras Ter Intensiva. 2017;29(4):490-498
DOI 10.5935/0103-507X.20170068
Views0See moreABSTRACT
Dobutamine is the inotrope most commonly used in septic shock patients to increase cardiac output and correct hypoperfusion. Although some experimental and clinical studies have shown that dobutamine can improve systemic and regional hemodynamics, other research has found that its effects are heterogenous and unpredictable. In this review, we analyze the pharmacodynamic properties of dobutamine and its physiologic effects. Our goal is to show that the effects of dobutamine might differ between healthy subjects, in experimental and clinical cardiac failure, in animal models and in patients with septic shock. We discuss evidence supporting the claim that dobutamine, in septic shock, frequently behaves as a chronotropic and vasodilatory drug, without evidence of inotropic action. Since the side effects are very common, and the therapeutic benefits are unclear, we suggest that dobutamine should be used cautiously in septic shock. Before a definitive therapeutic decision, the efficacy and tolerance of dobutamine should be assessed during a brief time with close monitoring of its positive and negative side effects.
Views0Abstract
Review ArticlesThe spectrum of cardiovascular effects of dobutamine – from healthy subjects to septic shock patients
Rev Bras Ter Intensiva. 2017;29(4):490-498
DOI 10.5935/0103-507X.20170068
Views0See moreABSTRACT
Dobutamine is the inotrope most commonly used in septic shock patients to increase cardiac output and correct hypoperfusion. Although some experimental and clinical studies have shown that dobutamine can improve systemic and regional hemodynamics, other research has found that its effects are heterogenous and unpredictable. In this review, we analyze the pharmacodynamic properties of dobutamine and its physiologic effects. Our goal is to show that the effects of dobutamine might differ between healthy subjects, in experimental and clinical cardiac failure, in animal models and in patients with septic shock. We discuss evidence supporting the claim that dobutamine, in septic shock, frequently behaves as a chronotropic and vasodilatory drug, without evidence of inotropic action. Since the side effects are very common, and the therapeutic benefits are unclear, we suggest that dobutamine should be used cautiously in septic shock. Before a definitive therapeutic decision, the efficacy and tolerance of dobutamine should be assessed during a brief time with close monitoring of its positive and negative side effects.
-
Original Article
Prognostic value of ventricular diastolic dysfunction in patients with severe sepsis and septic shock
Rev Bras Ter Intensiva. 2015;27(4):333-339
Abstract
Original ArticlePrognostic value of ventricular diastolic dysfunction in patients with severe sepsis and septic shock
Rev Bras Ter Intensiva. 2015;27(4):333-339
DOI 10.5935/0103-507X.20150057
Views0See moreABSTRACT
Objectives:
To evaluate the prevalence of myocardial dysfunction and its prognostic value in patients with severe sepsis and septic shock.
Methods:
Adult septic patients admitted to an intensive care unit were prospectively studied using transthoracic echocardiography within the first 48 hours after admission and thereafter on the 7th-10th days. Echocardiographic variables of biventricular function, including the E/e’ ratio, were compared between survivors and non-survivors.
Results:
A total of 99 echocardiograms (53 at admission and 46 between days 7 – 10) were performed on 53 patients with a mean age of 74 (SD 13) years. Systolic and diastolic dysfunction was present in 14 (26%) and 42 (83%) patients, respectively, and both types of dysfunction were present in 12 (23%) patients. The E/e’ ratio, an index of diastolic dysfunction, was the best predictor of hospital mortality according to the area under the ROC curve (0.71) and was an independent predictor of outcome, as determined by multivariate analysis (OR = 1.36 [1.05 – 1.76], p = 0.02).
Conclusion:
In septic patients admitted to an intensive care unit, echocardiographic systolic dysfunction is not associated with increased mortality. In contrast, diastolic dysfunction is an independent predictor of outcome.
Views0Abstract
Original ArticlePrognostic value of ventricular diastolic dysfunction in patients with severe sepsis and septic shock
Rev Bras Ter Intensiva. 2015;27(4):333-339
DOI 10.5935/0103-507X.20150057
Views0See moreABSTRACT
Objectives:
To evaluate the prevalence of myocardial dysfunction and its prognostic value in patients with severe sepsis and septic shock.
Methods:
Adult septic patients admitted to an intensive care unit were prospectively studied using transthoracic echocardiography within the first 48 hours after admission and thereafter on the 7th-10th days. Echocardiographic variables of biventricular function, including the E/e’ ratio, were compared between survivors and non-survivors.
Results:
A total of 99 echocardiograms (53 at admission and 46 between days 7 – 10) were performed on 53 patients with a mean age of 74 (SD 13) years. Systolic and diastolic dysfunction was present in 14 (26%) and 42 (83%) patients, respectively, and both types of dysfunction were present in 12 (23%) patients. The E/e’ ratio, an index of diastolic dysfunction, was the best predictor of hospital mortality according to the area under the ROC curve (0.71) and was an independent predictor of outcome, as determined by multivariate analysis (OR = 1.36 [1.05 – 1.76], p = 0.02).
Conclusion:
In septic patients admitted to an intensive care unit, echocardiographic systolic dysfunction is not associated with increased mortality. In contrast, diastolic dysfunction is an independent predictor of outcome.
-
Original Articles
Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment
Rev Bras Ter Intensiva. 2014;26(1):13-20
Abstract
Original ArticlesAugmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment
Rev Bras Ter Intensiva. 2014;26(1):13-20
DOI 10.5935/0103-507X.20140003
Views8Objective:
An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the effects on vancomycin concentrations and dosing in a series of intensive care unit patients.
Methods:
We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120mL/min/1.73m2), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered.
Results:
Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p<0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations.
Conclusions:
In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing.
Keywords:CreatinineMetabolic clearance rateSepsis/drug therapyVancomycin/pharmacokineticsVancomycin/therapeutic useSee moreViews8Abstract
Original ArticlesAugmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment
Rev Bras Ter Intensiva. 2014;26(1):13-20
DOI 10.5935/0103-507X.20140003
Views8Objective:
An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the effects on vancomycin concentrations and dosing in a series of intensive care unit patients.
Methods:
We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120mL/min/1.73m2), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered.
Results:
Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p<0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations.
Conclusions:
In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing.
Keywords:CreatinineMetabolic clearance rateSepsis/drug therapyVancomycin/pharmacokineticsVancomycin/therapeutic useSee more
Search
Search in:
KEY WORDS
Case reports Child Coronavirus infections COVID-19 Critical care Critical illness ICU Infant, newborn Intensive care Intensive care units Intensive care units, pediatric mechanical ventilation Mortality Physical therapy modalities Prognosis Respiration, artificial Respiratory insufficiency risk factors SARS-CoV-2 Sepsis