In an endotoxaemic model, antibiotic clearance can be affected by different central venous catheter positions, during renal replacement therapy

Intensive Care Medicine Experimental

Research Articles

Anders Larsson¹  David Smekal²  Robert Frithiof²  Anna Bandert³  Miklós Lipcsey⁴ 

[1] Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden;Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden;Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden;Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden;Department of Anaesthesiology and Intensive Care, Gävle Hospital, Lasarettvägen 1, 80324, Gävle, Sweden;Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden;Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden;

关键词: Central venous catheter;    Intensive care;    Continuous renal replacement therapy antibiotic concentration;    Sepsis;    Dialysis;    Acute kidney injury;   

DOI  :  10.1186/s40635-023-00516-4

 received in 2023-02-09, accepted in 2023-04-25,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIn intensive care, different central venous catheters (CVC) are often used for infusion of drugs. If a patient is treated with continuous renal replacement therapy (CRRT) a second catheter, a central venous dialysis catheter (CVDC), is needed. Placing the catheters close together might pose a risk that a drug infused in a CVC could be directly aspirated into a CRRT machine and cleared from the blood without giving the effect intended. The purpose of this study was to elucidate if drug clearance is affected by different catheter placement, during CRRT. In this endotoxaemic animal model, an infusion of antibiotics was administered in a CVC placed in the external jugular vein (EJV). Antibiotic clearance was compared, whether CRRT was through a CVDC placed in the same EJV, or in a femoral vein (FV). To reach a target mean arterial pressure (MAP), noradrenaline was infused through the CVC and the dose was compared between the CDVDs.ResultsThe main finding in this study was that clearance of antibiotics was higher when both catheter tips were in the EJV, close together, compared to in different vessels, during CRRT. The clearance of gentamicin was 21.0 ± 7.3 vs 15.5 ± 4.2 mL/min (p 0.006) and vancomycin 19.3 ± 4.9 vs 15.8 ± 7.1 mL/min (p 0.021). The noradrenaline dose to maintain a target MAP also showed greater variance with both catheters in the EJV, compared to when catheters were placed in different vessels.ConclusionThe results in this study indicate that close placement of central venous catheter tips could lead to unreliable drug concentration, due to direct aspiration, during CRRT.

【 授权许可】

CC BY   
© The Author(s) 2023

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