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U F Kroh

Publications and source records attributed to U F Kroh.

3 recordsLinked to original sources
PubMed1992

Evaluation and first validation study on a simplified drug dosage algorithm for multiple organ failure patients.

As reported previously, drug concentrations during continuous hemofiltration (HF) and extracorporeal lung assist (ELA) follow certain rules, which can be expressed by a simplified algorithm for dosage adjustment: Drug sieving (S, fu) depends on the protein free fraction with small limitations, while the extrarenal elimination rate is not a constant but correlates inversely with the clinical state, r = -0.34, p = 0.00067, n = 96. Up to now, more than 218 cases of drug dosage adjustments have been performed, following the described regimen: The expected concentration is obtained in 79-84% already from the first estimation for drugs such as aminoglycosides, vancomycin, teicoplanin, beta-lactam antibiotics, heart glycosides, and theophylline. Skilled therapeutic drug monitoring (TDM) with elaborated pharmacokinetic programs fails to improve these results significantly. Nevertheless, sporadic TDM is essential in these patients according to their rapidly changing clinical states.

Acute Kidney Injury↗
PubMed1991

[Drugs in the intensive care unit--need for dosage adjustment in organ failure].

Drug dosage in intensive care patients is a common problem that cannot be sufficiently solved in practice. To obtain an idea as to the variance of multiorgan failure during treatment, the pharmacokinetics of 17 drugs were evaluated in 96 patients. Continuous hemofiltration served as a model for constant elimination rates. In addition, the elimination of drugs was investigated during extracorporeal lung support. For 11 of 15 drugs on which kinetic studies had been completed, dose reductions had to be performed. Furthermore, widespread variance in their volume of distribution and their clearance and in the extrarenal fraction of elimination were detected. The latter showed a close correlation to clinical scores of illness. This led us to develop a new algorithm for primary estimations of drug dosage during hemofiltration. In a preliminary validation study, the algorithm seemed to show an improvement in the drug dosage in these populations. Nevertheless, a more simplified means of monitoring therapeutic drugs should be continued, especially for toxic agents.

Critical Care↗