Abstract
Meropenem is a new carbapenem antibiotic with a broad spectrum of activity against Gram-positive and Gram-negative strains including β-lactamase producers. Thus, it is particularly useful in intensive care patients (pts) with septic complications due to unknown pathogens. The present study was conducted to evaluate the pharmacokinetic properties of meropenem in nine critically ill patients treated by continuous venovenous hemofiltration (CVVH). All pts received one single dose of 1 g meropenem intravenously. High-flux polysulfone membranes (Diafilter-30, Amicon, Ireland) were used as dialyzer. Meropenem serum concentrations as well as filtrate aliquots were determined by high-performance liquid chromatography. Peak serum concentrations were 28.1 ± 2.7 μg/ml, trough levels 6.6 ± 1.5 μg/ml after 6 h CVVH. The post-to-pre hemodialysis ratio was 0.24 ± 0.06, total removal was 35.8 ± 10.1% and the mean difference of meropenem concentration between arterial and venous line was 23.4 ± 4.9%. The calculated pharmacokinetic parameters were: half-life 2.3 ± 0.4 h, elimination constant 0.31 ± 0.05 h-1, AUC 118.0 ± 15.8 mg/l/h and the clearance during CVVH was 49.7 ± 8.3 ml/h. No side effects were seen. The calculated total daily meropenem requirements in these patients with acute renal failure and CVVH was 2482 ± 321 mg. Based upon these data we conclude that patients with severe infections on CVVH can be treated effectively with 1 g meropenem every 8 h.
Highlights
Ill patients requiring intensive care are at risk of iatrogenic ocular damage
Intensive Care Unit (ICU) management of critically ill patients often includes the requirement for tracheostomy and feeding access, most often a pecutaneous endoscopic gastrostomy (PEG)
Percutaneous tracheostomy is performed routinely in many medical intensive care unit (ICU) settings, in high risk surgical and trauma patients who often have unstable cervical spine injury and tissue edema, direct visualization of the cervical structures and trachea is imperative during tracheostomy
Summary
Ill patients requiring intensive care are at risk of iatrogenic ocular damage. We designed an experimental situation where external cardiac pressure conditions were controlled and adjusted to physiological extremes to mimic clinically relevant situations, while cardiac performance was assessed using left ventricular pressure–volume relationships (LVPVR) which are relatively preload and afterload independent This prospective, controlled study was undertaken to evaluate the response to therapy aimed at achieving supranormal cardiac and oxygen transport values (cardiac index >4.5 l/min/m2, oxygen delivery >600 l/min/m2, and oxygen consumption >170 l/min/m2) in patients older than 60 or with previous severe cardiorespiratory illnesses, who have undergone elective extensive ablative surgery planned for carcinoma or abdominal aortic aneurism. Whilst some human studies conducted in the critically ill and in high risk surgical patients have suggested that dopexamine may cause an increase in tonometrically measured gastric intra-mucosal pH (pHi) and an improvement in clinical outcome, this has not been confirmed in other randomised trials. In the present study the association of platelet function to inflammatory markers indicating disease severity was investigated
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