NDLI: Prediction of distribution volume of vancomycin in critically ill patients using extravascular lung water and pulmonary vascular permeability indices.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Imaura, Masaharu Yokoyama, Haruko Kohyama, Tomoki Nagafuchi, Hiroyuki Kohata, Yuji Takahashi, Hiroyuki Yamada, Yasuhiko
Spatial Coverage	Japan
Description	Country affiliation: Japan Author Affiliation: Imaura M ( Department of Clinical Evaluation of Drug Efficacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan.)
Abstract	OBJECTIVE: Alterations in distribution volume affect the concentrations of hydrophilic drugs in plasma and tissues at the time of initial therapy. When the distribution volume of hydrophilic antimicrobials is increased in critically ill patients with a serious infection, antimicrobial concentrations are reduced, which may adversely affect the efficacy of antimicrobial therapy. A transpulmonary thermodilution technique system (PiCCO) enables measurements of pulmonary vascular permeability index (PVPI) and extravascular lung water index (EVLWI), which are related to pulmonary edema and pulmonary vascular permeability, respectively. In addition, those indices may also be related to the distribution volume of hydrophilic antimicrobials. The aim of this study was to investigate the relationships of PVPI and EVLWI with the distribution volume of vancomycin (Vss), as well as to establish a method for estimating Vss for planning an appropriate initial dose for individual patients. METHODS: Seven patients were administered vancomycin intravenously and underwent extended hemodynamic monitoring with the PiCCO system in the intensive care unit (ICU) from April 2009 to March 2011. Vss was calculated using the Bayesian method, and the relationships of PVPI and EVLWI with Vss were investigated. RESULTS: The relationship between Vss/actual body weight (ABW) and median EVLWI on days when blood levels were measured was significant (r = 0.900, p = 0.0057), whereas the relationship between Vss/ABW and PVPI was not significant (r = 0.649, p = 0.1112). CONCLUSION: EVLWI determined by the PiCCO system is useful to predict Vss and should lead to more effective vancomycin therapy for critically ill patients at the initial stage.
File Format	HTM / HTML
ISSN	09461965
Issue Number	11
Volume Number	50
Journal	Int. Journal of Clinical Pharmacology and Therapeutics
Language	English
Publisher	Dustri-Verlag
Publisher Date	2012-11-01
Publisher Place	Germany
Access Restriction	Subscribed
Subject Keyword	Discipline Pharmacology Anti-bacterial Agents Pharmacokinetics Capillary Permeability Extravascular Lung Water Metabolism Lung Blood Supply Pulmonary Edema Vancomycin Aged Aged, 80 And Over Administration & Dosage Blood Chemistry Bayes Theorem Critical Illness Female Hemodynamics Humans Hydrophobic And Hydrophilic Interactions Japan Male Middle Aged Models, Statistical Monitoring, Physiologic Retrospective Studies Thermodilution Tissue Distribution Journal Article
Content Type	Text
Resource Type	Article
Subject	Pharmacology Pharmacology (medical)

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