• D A Tholl, L R Shikuma, T Q Miller, J M Woodward, F B Cerra, and D E Zaske.
• Section of Clinical Pharmacy, St. Paul-Ramsey Medical Center, MN 55101.
• Crit. Care Med. 1993 Feb 1;21(2):248-51.

ObjectiveTo examine the relationships between aminoglycoside clearance and physiologic parameters associated with the physiologic response to injury.DesignCross-sectional study of surgical patients receiving aminoglycoside pharmacokinetic monitoring and parenteral nutritional support.SettingAn adult surgical ICU.PatientsFifty-four surgical/trauma patients who had Gram-negative sepsis.InterventionsMeasurements of the physiologic stress response to injury were associated with aminoglycoside clearance in 54 surgical/trauma patients who had Gram-negative sepsis. Measurements used to estimate the magnitude of the stress response included a 24-hr urinary urea nitrogen excretion, blood urea nitrogen, peak temperature, serum albumin, bilirubin, and transferrin concentrations.Measurements And Main ResultsMean drug clearance rate (4.4 +/- 2.5 [SD] L/hr) was related to the physiologic measurements using correlation and regression techniques. Collectively, all physiologic indices (utilized) explained 59% of the variance in drug clearance (p < .001), an amount similar to the variance explained by creatinine clearance alone (53%). When all six physiologic measurements were included into a multiple regression model that included creatinine clearance, the total variance explained increased to 73%.ConclusionsAlong with renal function estimates, the physiologic response to stress should be considered when treating critically ill patients with aminoglycosides and other, similar, renally eliminated drugs.

30 keywords...

hide…