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Title of Journal: Intensive Care Med

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Abbravation: Intensive Care Medicine

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Springer-Verlag

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DOI

10.1002/jcc.20399

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1432-1238

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Discrepancies between observed and predicted conti

Authors: Catherine S C Bouman Hendrikus J M van Kan Richard P Koopmans Johanna C Korevaar Marcus J Schultz Margreeth B Vroom
Publish Date: 2006/10/17
Volume: 32, Issue: 12, Pages: 2013-2019
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Abstract

Drug dosing during continuous venovenous hemofiltration CVVH is based partly upon the CVVH clearance ClCVVH of the drug ClCVVH is the product of the sieving coefficient SC and ultrafiltration rate Quf Although it has been suggested that the SC can be replaced by the fraction of a drug not bound to protein Fup the Fup values as reported in the literature may not reflect the protein binding in critically ill patients with renal failure We compared the observed ClCVVH SC × Quf with the estimated ClCVVH estimated FUP × Quf and determined the effect on the maintenance dose multiplication factor MDMFAmoxicillin ceftazidime ciprofloxacin fluconazole metronidazole and vancomycin were easily filtered mean SC  07 but not flucloxacillin mean SC 03 Predicted and observed ClCVVH corresponded only for fluconazole and metronidazole The difference between observed and predicted MDMF was small for all drugs with the exception of ceftazidime mean 025 95 CI −096 to 148 and vancomycin 005 −134 to 145 However this difference was clinically relevant only for vancomycin because of its narrow therapeutic index

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