The use of antimicrobials in septic patients with acute kidney injury

Abstract

Sepsis is the most common cause of death in critically ill patients and it may be associated with multiorgan failure, including acute kidney injury (AKI). This situation can require acute renal support and increase mortality. Therefore, it is essential to administrate antimicrobials in dosis to achieve adequate serum levels, preventing overdosis and drug toxicity or underdosing and risk for resistance to antibiotics and higher mortality. To date, there aren't validated guidelines on antibiotic dosis adjustment in septic patients with AKI and the recommendations are extrapolated from studies conducted in non-critical patients with chronic kidney disease in end stage receiving chronic renal replacement therapy. This study aimed to review and discuss the complexity of that issue, considering the several factors related to the drugs removal: critically ill patient characteristics, antimicrobial properties and dialysis method.

Manejo de enfermagem para paciente hemodialítico na Unidade de Terapia Intensiva: revisão integrativa

“…Assim, para que se estabeleça um cuidado mais seguro na UTI, há a necessidade de preparação do paciente dialítico, visto que ele dialisará em média 4 horas. O profissional enfermeiro deve, portanto, adotar medidas pré-hemodiálise, como a organização da rotina, dos horários e ajustes de aprazamento de alguns antibióticos, procedimentos, garantir a higiene e perfusão de vias aéreas (Freitas et al, 2017).…”

“…As realizações das atividades que subsidiam o manejo de enfermagem ao paciente após a hemodiálise compreendemse em aferir sinais vitais (PA, FC, FR, T e SatO2) após o procedimento e compará-los aos valores pré diálises, anotar e registrar em Balanço Hídrico a Taxa de Ultrafiltração (perdas) atingida durante o procedimento, auxiliando na monitorização hídrica e controle da hipervolemia e cuidados com os curativos dos acessos vasculares, cateter venoso central e/ou fístula arteriovenosa (FAV) (Ribeiro, 2016, Melo et al, 2019, Lucena et al, 2017. Dentre as ações de Enfermagem no período pós hemodiálise também inserido por Freitas et al, (2017) compreende os cuidados com o acesso vascular, monitorização dos sinais vitais, do paciente e investigação de sinais e sintomas gerais.…”

Vancomycin dosing, monitoring and toxicity: Critical review of the clinical practice

“…Among patients with stage 5 chronic kidney disease receiving some renal replacement therapy or critically ill patients on acute renal support therapy and concomitant administration of vancomycin, the drug elimination during therapy should be based on dose adjustment . Vancomycin clearance by dialysis depends on the type of dialysis membrane, dialysis fluxes and duration, ultrafiltration rate, and Kt/V .…”

“…In continuous venovenous therapies, there is no rebound effect on serum concentration, and the level can be determined at any time . Continuous infusion seems to be more successful in fulfilling pharmacokinetic/pharmacodynamic needs in this population, but few studies have addressed this theme .…”

“…According to a narrative review conducted by Freitas et al , the dose of 15 mg/kg should be administered after the dialysis for conventional HD therapies in daily regimen (or according to serum level), 500 mg every 24‐48 hours in continuous venovenous therapies, 7.5 mg/kg every 2‐3 days for continuous ambulatory peritoneal dialysis (CAPD). There is no specific information about doses for patients receiving extended HD therapy or high volume PD.…”