Original Article
The Effect of Modified Ultrafiltration on Serum Vancomycin Levels During Cardiopulmonary Bypass in Cardiac Surgery

https://doi.org/10.1053/j.jvca.2018.06.004Get rights and content

Objective

The aim of this study was to investigate whether the use of modified ultrafiltration at the end of cardiopulmonary bypass for cardiac surgical procedures significantly changes vancomycin serum concentrations.

Design

Prospective study.

Setting

Single tertiary cardiac center.

Participants

Twenty-six elective adult patients undergoing cardiac surgery with cardiopulmonary bypass from April 2014 to April 2015.

Interventions

Serum vancomycin concentrations were measured just before cardiopulmonary bypass; during cardiopulmonary bypass at 5, 30, 60 minutes and then every 60 minutes; after completion of cardiopulmonary bypass before initiation of modified ultrafiltration; and at the end of modified ultrafiltration.

Measurements and Main Results

Seventeen patients received modified ultrafiltration at the end of cardiopulmonary bypass. Serum vancomycin concentrations prior to cardiopulmonary bypass (45.9 ± 17.3 μg/mL) were significantly higher (P < 0.0001) than each time point following cardiopulmonary bypass (5 min 20.4 ± 6.4 μg/mL, 30 min 18.8 ± 5.4 μg/mL, 60 min 16.6 ± 4.9 μg/mL, and 120 min 14.3 ± 4.7 μg/mL). In the modified ultrafiltration group, serum vancomycin concentrations were 14.7 ± 4.6 μg/mL prior to modified ultrafiltration and 13.9 ± 4.3 μg/mL after ultrafiltration; this difference was statistically significant (P  =  0.0288). The mean modified ultrafiltration volume was 465 ± 158 mL.

Conclusions

Using modified ultrafiltration at the end of cardiopulmonary bypass significantly decreases serum vancomycin levels, but not by a clinically relevant amount. The decrease is to a concentration that is still significantly higher than the minimum inhibitory concentration for Staphylococcus epidermidis and Staphylococcus aureus; thus additional vancomycin administration is not recommended.

Section snippets

Methods

Twenty-six elective adult cardiac surgery patients were enrolled for this single-center prospective study conducted at UF Health Shands Hospital at the University of Florida from April 2014 to April 2015. The study was approved by the Institutional Review Board of University of Florida and was conducted in compliance with the standards set forth in the Helsinki Declaration. Written informed consent was obtained from each subject before the enrollment.

The inclusion criteria were: age greater

Results

Twenty-six patients were enrolled. One patient was not studied because surgery was cancelled. Seventeen patients underwent MUF at the end of CPB. Table 1 shows the demographic data of enrolled patients and patients who received MUF. Serum vancomycin concentrations prior to CPB (45.9 ± 17.3 μg/mL) were significantly higher (P < 0.0001) than each time point following CPB (5 minutes 20.4 ± 6.4 μg/mL, 30 minutes 18.8 ± 5.4 μg/mL, 60 minutes 16.6 ± 4.9 μg/mL, and 120 minutes 14.3 ± 4.7 μg/mL).

Discussion

This is the first study describing the effects of MUF after separation from CPB on serum vancomycin concentration. The main finding of this work is that MUF is associated with a statistically significant, but not clinically relevant reduction in serum vancomycin concentration.

MUF is a well-known technique of arteriovenous hemofiltration often used after termination of CPB to reduce total body water and associated with potential beneficial effects in terms of reduced blood transfusions, and

Acknowledgements

Funding was provided by the Jerome H Modell endowed professorship (N.G.).

References (22)

  • GM Ortega et al.

    Alteration of vancomycin pharmacokinetics during cardiopulmonary bypass in patients undergoing cardiac surgery

    Am J Health-Syst Pharm

    (2003)
  • Funding: Funding was provided by the Jerome H Modell endowed professorship (N.G.).

    Conflicts of Interest: The authors declare no conflicts of interest.

    1

    Ettore Crimi, MD, Associate Professor, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida. Present institution: Department of Anesthesia and Critical Care, Ocala Regional Medical Center, University of Central Florida, Ocala, Florida

    2

    Daniel Hernandez-Barajas, MD, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida. Present institution: Staff Anesthesiologist, North Florida South Georgia VA Medical Center, Gainesville, Florida

    3

    Aaron Seller, DO, Cardiothoracic Anesthesiologist, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida. Present institution: Department of Anesthesiology, First Health Moore Regional Hospital, Pinehurst, North Carolina

    4

    Jennifer Ashton, PharmD, Pharmacist, UF Health Shands Hospital, Department of Pharmacy, Gainesville, Florida

    5

    Mark Martin, CCP, Director of Perfusion, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida. Present institution: Redline Perfusion & Consulting, LLC, Gainesville, Florida

    6

    Terrie Vasilopoulos, PhD, Assistant Professor in Anesthesiology and Orthopedics and Rehabilitation, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida

    7

    Nikolaus Gravenstein, MD, Jerome H. Modell, MD, Professor of Anesthesiology, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida

    View full text