Furukawa Taku, Lankadeva Yugeesh, Baldwin Ian Charles, Ow Pei Chen Connie, Hood Sally, May Clive, Bellomo Rinaldo
Preclinical Critical Care Unit, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia,
Preclinical Critical Care Unit, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
Blood Purif. 2023;52(11-12):880-887. doi: 10.1159/000534108. Epub 2023 Oct 19.
Hemoadsorption has emerged as an adjunctive therapy for sepsis, but its impact on antibiotic levels remains poorly defined. We conducted an in vivo experimental study to investigate the removal of vancomycin and gentamicin during hemoadsorption using the HA380 cartridge, a novel styrene-divinylbenzene copolymer cartridge.
Six surgically prepared sheep were administered 2 g of vancomycin and 400 mg of gentamicin over 30 min, followed by a continuous infusion of vancomycin (20 mg/h). Hemoadsorption was implemented with a styrene-divinylbenzene copolymer HA380 cartridge at a blood flow of 120 mL/min. The removal ratio, sorbent-based clearance, and the mass removal rate were calculated for each time point.
The mean 10-min vancomycin removal ratio exceeded 90% and declined to 68.0% at 30 min; 52.8% at 60 min, and 28.0% by 4 h. Due to constant plasma flow, clearance varied proportionally with the removal ratio. Over 4 hours, the total mass removal was 556 mg (SD 106.3). For gentamicin, the mean 10-min removal ratio was 96.9% and the final ratio at 4 h remained 53.0%, with clearances changing proportionately. The total mass removal of gentamicin was 138 mg (SD 26.6) over 4 h. The sorbent-based clearance of vancomycin was significantly lower than that of gentamicin (Pgroup < 0.0001).
The novel HA380 sorbent cartridge appears safe and achieves significant vancomycin and gentamicin removal over a four-hour period. This information can be used by clinicians to guide their prescription and consider the additional dosing of at least an extra 25-35% amount in patients receiving HA380 hemoadsorption therapy during sepsis.
血液吸附已成为脓毒症的一种辅助治疗方法，但其对抗生素水平的影响仍不清楚。我们进行了一项体内实验研究，以调查使用新型苯乙烯 - 二乙烯基苯共聚物滤器HA380进行血液吸附期间万古霉素和庆大霉素的清除情况。
对六只通过手术准备的绵羊在30分钟内给予2克万古霉素和400毫克庆大霉素，随后持续输注万古霉素（20毫克/小时）。使用苯乙烯 - 二乙烯基苯共聚物HA380滤器以120毫升/分钟的血流速度进行血液吸附。计算每个时间点的清除率（removal ratio）、基于吸附剂的清除率（sorbent-based clearance）和质量清除率（mass removal rate）。
万古霉素的平均10分钟清除率超过90%，在30分钟时降至68.0%；60分钟时为52.8%，4小时时为28.0%。由于血浆流量恒定，清除率与清除率成比例变化。4小时内，总质量清除量为556毫克（标准差106.3）。对于庆大霉素，平均10分钟清除率为96.9%，4小时时的最终清除率仍为53.0%，清除率也相应变化。庆大霉素在4小时内的总质量清除量为138毫克（标准差26.6）。万古霉素基于吸附剂的清除率明显低于庆大霉素（P组<0.0001）。
新型HA380吸附剂滤器似乎是安全的，并且在四小时内可显著清除万古霉素和庆大霉素。临床医生可利用这些信息指导处方，并考虑在脓毒症患者接受HA380血液吸附治疗期间至少额外增加25 - 35%的剂量。
