Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy,
International renal Research Institute of Vicenza, Vicenza, Italy,
Nephron. 2021;145(2):157-163. doi: 10.1159/000513122. Epub 2021 Feb 10.
A critical point for using blood purification during sepsis may be the potential interaction with antimicrobial therapy, the mainstay of sepsis treatment. The aim of our study was to investigate the vancomycin removal during hemoperfusion (HP) using HA380 cartridge.
This is an experimental study, in which 500 mL of solution was circulated in a closed-circuit (blood flow of 250 mL/min) simulating HP ran using HA380. Vancomycin was added to reach a through concentration or a very high concentration to evaluate the removal ratio (RR) during 120 min of HP. Comparison between blood-crystalloid solution and balanced solution was performed by using Kruskal-Wallis test. The kinetics of vancomycin removal and the adsorption isotherm were evaluated.
We found a complete removal of vancomycin at baseline through concentration of 23.0 ± 7.4 mg/L. Using extremely high concentration (baseline 777.0 ± 62.2 mg/L), RR was 90.1 ± 0.6% at 5 min and 99.2 ± 0.6% at 120 min. No difference in terms of RR was found between blood-crystalloid mixture and balanced solution. The kinetics of the vancomycin reduction followed an exponential decay. Repeated boluses (total amount of 2,000 mg) resulted in cumulative adsorption of 1,919.4 mg with RR of 96.6 ± 1.4%, regardless of the amount injected (100 vs. 500 mg). Vancomycin adsorption onto HA380 followed the Langmuir isotherm model.
A considerable amount of vancomycin was rapidly removed during in vitro HP with HA380. Clinical studies are needed to determine whether this may lead to underdosing. Drug therapeutic monitoring is highly recommended when using HA380 for blood purification in patients receiving vancomycin.
在脓毒症中使用血液净化的一个关键问题可能是与抗菌治疗的潜在相互作用，这是脓毒症治疗的主要手段。我们的研究目的是研究使用 HA380 试剂盒进行血液灌流（HP）时对万古霉素的清除作用。
这是一项实验研究，其中 500 毫升溶液在模拟 HP 的封闭回路（血流 250 毫升/分钟）中循环，使用 HA380 进行。加入万古霉素以达到通过浓度或非常高的浓度，以评估 120 分钟 HP 期间的清除率（RR）。通过 Kruskal-Wallis 检验比较血液-晶体溶液和平衡溶液。评估了万古霉素清除的动力学和吸附等温线。
我们发现，在通过浓度 23.0 ± 7.4 mg/L 时，万古霉素完全被清除。使用极高浓度（基线 777.0 ± 62.2 mg/L），RR 在 5 分钟时为 90.1 ± 0.6%，在 120 分钟时为 99.2 ± 0.6%。在 RR 方面，血液-晶体混合物和平衡溶液之间没有差异。万古霉素减少的动力学遵循指数衰减。重复推注（总量 2000 毫克）导致 1919.4 毫克的累积吸附，RR 为 96.6 ± 1.4%，与注射量无关（100 毫克与 500 毫克）。万古霉素吸附到 HA380 上遵循朗缪尔等温线模型。
在使用 HA380 进行体外 HP 时，大量万古霉素迅速被清除。需要进行临床研究以确定这是否会导致剂量不足。当使用 HA380 对接受万古霉素的患者进行血液净化时，强烈建议进行药物治疗监测。
