Population pharmacokinetics of amikacin in intensive care unit patients studied by NPEM algorithm.

The population pharmacokinetics of amikacin was studied in 40 intensive care unit patients (212 plasma concentrations) by NPEM algorithm using a one-compartment model. The population was best characterized by the following pharmacokinetic parameters: renal clearance relative to creatinine clearance (Cs = 0.96 +/- 0.33), and either the total volume of distribution (Vd = 23.9 +/- 7.0 l) or the volume of distribution relative to body weight (Vs = 0.36 +/- 0.10 l.kg-1. The volume of distribution was increased with respect to the usual value of 0.25 l.kg-1. The statistical distribution of these pharmacokinetic parameters was approximately gaussian, with no significant correlation between volume of distribution and clearance. The medians and standard deviations of Cs and Vs were used as reference population values to estimate the pharmacokinetics of amikacin in a second group of 29 patients by the bayesian method, with two blood samples per patient. For each patient, the fitted parameters were able to predict the plasma concentrations of amikacin during the next 72 h with no significant bias and good precision (2.9 mg.l-1 for peaks and 0.5 mg.l-1 for troughs). This study confirms the ability of the NPEM algorithm to provide reference population values for use in bayesian monitoring of aminoglycoside therapy.

Pharmacokinetics and dosage regimens of amikacin in intensive care unit patients.

The pharmacokinetics of amikacin have been studied in 40 intensive care unit (ICU) patients using a two-compartment model and the Bayesian estimation method implemented in the USC PC-PACK program of Jelliffe et al. The volume of the central compartment was significantly higher in these patients (0.36 l.kg-1) than in the reference population (0.20 l.kg-1). A method has been designed to compute dosage regimens in order to maintain a constant steady-state average plasma concentration of 8 mg.l-1 for repeated i.v. infusions. The regimen calculated for the 'average' ICU patient varies between 11 mg.kg-1 three times per day for the patient with normal renal function and 6 mg.kg-1 every 2 days for the anuric patient. This regimen is intended to begin amikacin therapy in an ICU patient, while the population pharmacokinetic parameters would allow the individualization of the regimen by means of the Bayesian method.

Population pharmacokinetic parameters for Bayesian monitoring of amikacin therapy in intensive care unit patients.

The pharmacokinetics of amikacin has been studied in 40 intensive care unit patients using the bayesian estimation method implemented in the USC PC PACK program of Jelliffe. The volume of the central compartment was significantly higher in these patients than in the reference population, while other pharmacokinetic parameters did not differ significantly from the reference values. The population values may be employed, in addition to those supplied with the software, to adapt dosage regimens of amikacin in ICU patients.

[Massive traumatic hemoptysis]. / Hémoptysie traumatique massive.

A case is reported of a patient who suffered a rupture of one lung as result of thoracic trauma. This gave rise to respiratory distress with massive haemoptysis which was initially treated with a double-lumen endotracheal tube, with separate lung ventilation, a chest drain and massive transfusion. A haemostatic pneumonectomy had to be performed because of the persisting and profuse bleeding.

[Peritonitis following cesarean section. Report of 2 cases. The value of laparostomy]. / Péritonite après césarienne. Rapport de deux cas, intérêt de la laparostomie.

The authors describe two cases of severe septic complications after caesarean section. They compare primary closure of the abdomen with the method of leaving it open. This should only be used very rarely but may help to shorten the stay in hospital and lessen the severity of the complications of severe peritonitis, which still today in these rare cases of surgery carry very heavy mortality.

[Oesophagitis during mechanical ventilation]. / Oesophagite au cours de la ventilation artificielle.

Twenty-one patients whose condition required mechanical ventilation with nasogastric intubation were investigated for oesophagitis before the 3rd day and on the 15th day of treatment, including endoscopy and biopsy. Lesions of oesophagitis were detected in 14 cases during the initial examination and in 19 cases on the second endoscopy. The course of the lesions varied from one patient to another and appeared to be unrelated to the course of the primary disease. Oesophagitis in these patients is probably due to frequent episodes of gastro-oesophageal reflux encouraged by cough, impaired consciousness and the presence of a tube. Reflux may also be the cause of inapparent and recurrent lung aspiration.

[Compared results of flail chests treatments : standard internal pneumatic stabilization, new technics of assisted ventilation, osteosynthesis (author's transl)]. / Résultats comparés du traitement des volets thoraciques : stabilisation pneumatique interne classique, nouvelle modalité de la ventilation artificielle, agrafage.

The analysis of 170 cases of flail chests, divide into three groups according to the type of treatment, proves the efficiency of the new technics of assisted ventilation and of the osteosynthesis by Judet clasps. The most significant advantages of those two complementary methods are a lowered mortality rate and a reduced frequency of refractory hypoxy and infectious complications.

[Acute renal insufficiency caused by phenyl-indane-dione. Apropos of 1 case]. / Insuffisance rénale aiguë à la phényl-indane-dione. A propos d'un cas.

One case of Phenindione (PID) adverse reaction is reported. The patient showed a typical picture of immunological reaction to the drug. In spite of severe bacteremia, she recovered. Only 33 cases of PID intolerance are reported in the literature. In all these patients, renal failure occurred. Superinfection is the most frequent cause of death. PID adverse reaction should be evoqued in the presence of signs such a fever, asthenia, anorexia and cutaneous reaction. The PID should be stopped immediatly but renal failure yet develops. During a PID treatment, frequent evaluation of blood azotemia, creatinine and proteinuria should be performed.