Central Venous Line and Dialysis Catheter Position Affects Drug Clearance during Continuous Renal Replacement Therapy in an Animal Model

被引:5
作者
Frithiof, Robert [1 ]
Bandert, Anna [1 ,2 ]
Larsson, Anders [3 ]
Lipcsey, Miklos [4 ]
Smekal, David [1 ]
机构
[1] Uppsala Univ, Dept Surg Sci, Sect Anesthesiol & Intens Care, Uppsala, Sweden
[2] Uppsala Univ Reg Gavleborg, Ctr Res & Dev, Uppsala, Sweden
[3] Uppsala Univ, Dept Med Sci, Sect Clin Chem, Uppsala, Sweden
[4] Uppsala Univ, Hedenstierna Lab, Dept Surg Sci, Sect Anesthesiol & Intens Care, Uppsala, Sweden
基金
瑞典研究理事会;
关键词
central venous catheter; continuous renal replacement therapy; intensive care; clearance; CRITICALLY-ILL PATIENTS; ACUTE KIDNEY INJURY; TRANSPULMONARY THERMODILUTION; SEPTIC SHOCK; RECIRCULATION; HEMODIALYSIS; NOREPINEPHRINE; DETERMINANT; MORTALITY; RISK;
D O I
10.1097/MAT.0000000000000839
中图分类号
R318 [生物医学工程];
学科分类号
0831 ;
摘要
In intensive care, drugs are commonly administered through central venous catheters (CVC). These catheters and central venous dialysis catheters (CVDC) are often placed in the same vessel for practical reasons. The aim of this experimental study was to investigate if the position of CVC and CVDC influences the elimination of infused drugs, during continuous renal replacement therapy (CRRT). In a randomized, cross-over model, anesthetized piglets received both a CVC and a CVDC in a jugular vein. Another CVDC was placed in a femoral vein for comparison. After baseline measurements, CRRT was performed in either of the CVDC, each CRRT-period separated by another baseline period. Hypotension was induced by peripherally given sodium nitroprusside. In the CVC, both gentamicin and noradrenaline were administered. Noradrenaline was titrated to reach a target blood pressure. When CRRT was performed using the CVDC in the same vessel as the drugs were infused, the plasma concentration of gentamicin was reduced compared with when the infusion and CVDC were in different vessels (5.66 [standard deviation (SD) +/- 1.23] vs. 7.76 [SD +/- 2.30] mg/l [p = 0.02]). The noradrenaline infusion rate needed to reach the target blood pressure was more than doubled (0.32 [SD +/- 0.16] vs. 0.15 [SD +/- 0.08] mu g/kg/min [p = 0.006]). This experimental study indicates that the removal of drugs is increased if infusion is in close vicinity of the CVDC, during CRRT.
引用
收藏
页码:408 / 413
页数:6
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