Antonio Alarcón | PubMed Health

PubMed2004

Disposition of instilled versus nebulized tobramycin and imipenem in ventilated intensive care unit (ICU) patients.

BACKGROUND: Delivery of antibiotics to the lower respiratory tract could potentially achieve antimicrobial bronchial drug concentrations without toxicity. AIM: To assess bronchial and serum concentrations of imipenem or tobramycin obtained by nebulization or instillation in critically ill mechanically ventilated patients. METHODS: Prospective randomized open trial. Eighteen patients ventilated for more than 48 h were included. Two doses of imipenem/cilastatin (1000/500 mg) separated by 8 h, or two doses of tobramycin 200 mg separated by 12 h were randomly nebulized or instilled into the tracheal tube. Five bronchoaspirates (two bronchoscopic, three blind) and five blood samples were collected on a timed schedule after the second dose. Respiratory and serum samples were analysed by HPLC, and a subset of blood samples was also evaluated by enzyme-immunoassay. RESULTS: When instilled, imipenem/cilastatin obtained higher concentrations in respiratory secretions than when nebulized (P=0.022, 1 h after the last dose; P=0.029, 2 h after the last dose). Tobramycin showed equally high concentrations when nebulized or instilled. Instillation of tobramycin may result in significant accumulation in patients with renal failure. CONCLUSIONS: High bronchial concentrations of imipenem could only be achieved by instillation, whereas tobramycin seems suitable for both modes of administration. Instillation of these antibiotics is a safe procedure that achieves high drug concentrations in respiratory secretions.

Administration, Inhalation↗

PubMed2004

The influence of delayed graft function.

We study the incidence of delayed graft function (DGF) in a group of 3365 renal transplant recipient patients from various Spanish centres, its clinical consequences, and the evolution in time (transplants performed in 1990, 1994 and 1998) of the factors that determine its presence. The incidence of DGF remained constant in the 3 years studied (30.4, 30.8 and 29.2%, respectively) when contrasting the following factors involved in the establishment of DGF were studied: body mass of recipient, donor age, non-heart beating donation, type of replacement treatment in the pre-transplant period, time of vascular anastomosis and time of cold ischaemia. DGF was not associated with graft or patient survival. In the transplants performed with elderly donors, the cold ischaemia time was associated with greater incidence of DGF, and the latter with less survival of the graft when censored for death. The presence of DGF was significantly associated with acute rejection, cytomegalovirus infection, worse renal function and arterial hypertension at 3 months post-transplantation. In conclusion, the incidence of DGF remained stable in our patients over the years studied and, although not directly, it can affect graft survival as it is associated with acute rejection, arterial hypertension and worse renal graft function. A shortening of ischaemia times may reduce the incidence of DGF and improve transplant results.

Adult↗