Original ArticleThe Effect of Modified Ultrafiltration on Serum Vancomycin Levels During Cardiopulmonary Bypass in Cardiac Surgery
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)
- et al.
The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice
Ann Thorac Surg
(2007) Ultrafiltration and modified ultrafiltration in pediatric open heart operations
Ann Thorac Surg
(1993)- et al.
Is single-dose antibiotic prophylaxis sufficient for coronary artery bypass surgery? An analysis of peri- and postoperative serum cefuroxime and vancomycin levels
J Hosp Infect
(1997) - et al.
Effects of cardio-pulmonary bypass on vancomycin plasma concentration decay
Pharmacol Res
(1998) - et al.
Vancomycin sequestration during cardiopulmonary bypass surgery
J Infect
(2002) Administration of parenteral prophylactic beta-lactam antibiotics in 2014: A review
Anesth Analg
(2015)- et al.
Clinical practice guidelines for antimicrobial prophylaxis in surgery
Am J Health Syst Pharm
(2013) - et al.
Modified ultrafiltration lowers adhesion molecule and cytokine levels after cardiopulmonary bypass without clinical relevance in adults
Eur J Cardiothorac Surg
(2000) - et al.
Effect of cardiopulmonary bypass on vancomycin and netilmicin disposition
Antimicrob Agents Chemother
(1988) - et al.
Pharmacokinetics of vancomycin administered as prophylaxis before cardiac surgery
Ther Drug Monit
(2000)
Alteration of vancomycin pharmacokinetics during cardiopulmonary bypass in patients undergoing cardiac surgery
Am J Health-Syst Pharm
Cited by (2)
Sequestration of Dexmedetomidine in Ex Vivo Cardiopulmonary Bypass Circuits
2022, ASAIO JournalAnesthesia Considerations in Infective Endocarditis
2022, Anesthesiology
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