Does the cytokine adsorber CytoSorb® reduce vancomycin exposure in critically ill patients with sepsis or septic shock? a prospective observational study

Autor: Christina Scharf, Ferdinand Weinelt, Ines Schroeder, Michael Paal, Michael Weigand, Michael Zoller, Michael Irlbeck, Charlotte Kloft, Josef Briegel, Uwe Liebchen
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Annals of Intensive Care, Vol 12, Iss 1, Pp 1-8 (2022)
Druh dokumentu: article
ISSN: 2110-5820
DOI: 10.1186/s13613-022-01017-5
Popis: Abstract Background Hemadsorption of cytokines is used in critically ill patients with sepsis or septic shock. Concerns have been raised that the cytokine adsorber CytoSorb® unintentionally adsorbs vancomycin. This study aimed to quantify vancomycin elimination by CytoSorb®. Methods Critically ill patients with sepsis or septic shock receiving continuous renal replacement therapy and CytoSorb® treatment during a prospective observational study were included in the analysis. Vancomycin pharmacokinetics was characterized using population pharmacokinetic modeling. Adsorption of vancomycin by the CytoSorb® was investigated as linear or saturable process. The final model was used to derive dosing recommendations based on stochastic simulations. Results 20 CytoSorb® treatments in 7 patients (160 serum samples/24 during CytoSorb®-treatment, all continuous infusion) were included in the study. A classical one-compartment model, including effluent flow rate of the continuous hemodialysis as linear covariate on clearance, best described the measured concentrations (without CytoSorb®). Significant adsorption with a linear decrease during CytoSorb® treatment was identified (p
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