Peter N Johnson, Eugenie Chang, Emily Cormack, Kaley Hornaday, Stephen B Neely, Courtney Ranallo, Hala Chaaban, Lucila Garcia-Contreras, Jamie L Miller
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Secondary objectives included a comparison of clinical characteristics between those with and without detectable concentrations and identification of patients with acute kidney injury (AKI) as defined by the Kidney Diseases Improving Global Outcomes (KDIGO) criteria.</p><p><strong>Methods: </strong>This was a single-center retrospective study of critically ill children <18 years without cystic fibrosis receiving inhaled tobramycin between July 1, 2016, and August 31, 2021. Data collection included demographics, tobramycin regimen, and renal function. Analysis was performed using SAS 9.4, with a <i>P</i>-value <0.05, and a multivariable regression model was performed to identify factors for detectable concentrations and AKI.</p><p><strong>Results: </strong>Forty-four patients (66 courses) were included, with an overall age of 0.83 years. Thirty (68%) patients had detectable concentrations and 9 (20.5%) developed AKI. No significant differences in demographics, diagnosis, mechanical ventilation settings, and number of nephrotoxins were noted between those with and without detectable concentrations or AKI. Multivariable regressions did not identify factors associated with detectable concentrations or AKI.</p><p><strong>Conclusion and relevance: </strong>Detectable concentrations occurred with the majority of courses, with AKI associated with approximately one-fourth of courses. 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引用次数: 0
摘要
背景:针对呼吸机相关气管炎或肺炎制定了一项方案,在机械呼吸机的吸气回路中,通过距离气管导管 30 厘米处的振动网状雾化器,每 12 小时为机械通气的儿童吸入 300 毫克妥布霉素:主要目标:确定可检测到的妥布霉素谷浓度>0.5 µg/mL的发生率。次要目标包括比较可检测到和未检测到妥布霉素谷浓度的患者的临床特征,以及根据肾脏疾病改善全球结果(KDIGO)标准确定急性肾损伤(AKI)患者:这是一项针对重症儿童的单中心回顾性研究:共纳入 44 名患者(66 个疗程),总年龄为 0.83 岁。有 30 名患者(68%)检测到了血药浓度,9 名患者(20.5%)出现了 AKI。在人口统计学、诊断、机械通气设置和肾毒素数量方面,检测到浓度或发生 AKI 的患者与未检测到浓度或发生 AKI 的患者之间没有明显差异。多变量回归没有发现与可检测浓度或 AKI 相关的因素:大多数疗程都出现了可检测到的浓度,约四分之一的疗程出现了 AKI。临床医生应考虑对所有接受吸入妥布霉素治疗的机械通气重症患儿进行谷值监测。
Detectable Concentrations With Inhaled Tobramycin in Critically Ill Infants and Children Following Implementation of Standardized Protocol.
Background: A protocol was established for ventilator-associated tracheitis or pneumonia using inhaled tobramycin 300 mg every 12 hours in mechanically ventilated children via a vibrating mesh nebulizer, 30 cm from the endotracheal tube in the inspiratory loop of the mechanical ventilator.
Objectives: The primary objective was to determine the incidence of detectable tobramycin trough concentrations >0.5 µg/mL. Secondary objectives included a comparison of clinical characteristics between those with and without detectable concentrations and identification of patients with acute kidney injury (AKI) as defined by the Kidney Diseases Improving Global Outcomes (KDIGO) criteria.
Methods: This was a single-center retrospective study of critically ill children <18 years without cystic fibrosis receiving inhaled tobramycin between July 1, 2016, and August 31, 2021. Data collection included demographics, tobramycin regimen, and renal function. Analysis was performed using SAS 9.4, with a P-value <0.05, and a multivariable regression model was performed to identify factors for detectable concentrations and AKI.
Results: Forty-four patients (66 courses) were included, with an overall age of 0.83 years. Thirty (68%) patients had detectable concentrations and 9 (20.5%) developed AKI. No significant differences in demographics, diagnosis, mechanical ventilation settings, and number of nephrotoxins were noted between those with and without detectable concentrations or AKI. Multivariable regressions did not identify factors associated with detectable concentrations or AKI.
Conclusion and relevance: Detectable concentrations occurred with the majority of courses, with AKI associated with approximately one-fourth of courses. Clinicians should consider utilizing trough monitoring for all mechanically ventilated critically ill children receiving inhaled tobramycin.
期刊介绍:
Annals of Pharmacotherapy (AOP) is a peer-reviewed journal that advances pharmacotherapy throughout the world by publishing high-quality research and review articles to achieve the most desired health outcomes.The articles provide cutting-edge information about the most efficient, safe and cost-effective pharmacotherapy for the treatment and prevention of various illnesses. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 14 days