Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
Curr Opin Anaesthesiol. 2010 Aug;23(4):472-8. doi: 10.1097/ACO.0b013e328339ef0a.
The purpose of this review is to highlight the recently published studies in the area of pharmacokinetics and pharmacodynamics in critically ill patients and ascertain the relevance to clinical practice.
The majority of the published studies in this area were related to antibiotics and this will form the main focus of this review. A number of studies have focused on antibiotic concentrations at various target sites of infection or other tissue sites including cerebrospinal fluid, peritoneal fluid and burns tissues. The administration of time-dependent antibiotics using continuous infusion has also been the subject of recently published studies which support the superior achievement of pharmacodynamic targets using continuous infusion compared with bolus dosing. Antibiotic dosing during renal replacement therapies, mainly during extended daily dialysis (EDD) and during other forms of extracorporeal techniques including extracorporeal membrane oxygenation (ECMO), have also been described in a few recent studies and case reports.
Studies have shown that critically ill patients display large variations in pharmacokinetics mainly due to altered pathophysiology. An understanding of the pathophysiological changes that occur in critically ill patients is essential to optimize dosing particularly to achieve the pharmacodynamic targets for antibiotics.
本篇综述的目的是强调最近发表的有关危重病患者药代动力学和药效动力学的研究，并确定其与临床实践的相关性。
该领域发表的大多数研究都与抗生素有关，这将是本综述的主要重点。一些研究集中在感染的各种靶部位或其他组织部位（包括脑脊液、腹腔液和烧伤组织）的抗生素浓度上。使用持续输注给予时间依赖性抗生素也一直是最近发表的研究的主题，这些研究支持与单次推注相比，使用持续输注更能达到药效学目标。在肾脏替代治疗期间，特别是在延长每日透析（EDD）期间以及在其他形式的体外技术（包括体外膜氧合（ECMO））期间，抗生素的给药也在一些最近的研究和病例报告中进行了描述。
研究表明，危重病患者的药代动力学表现出很大的变化，主要是由于病理生理学的改变。了解危重病患者发生的病理生理学变化对于优化剂量特别对于实现抗生素的药效学目标至关重要。
