Reliability of mini-bronchoalveolar lavage for the measurement of epithelial lining fluid concentrations of tobramycin in critically ill patients
Reliability of mini-bronchoalveolar lavage for the measurement of epithelial lining fluid concentrations of tobramycin in critically ill patients
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DOI：
10.1007/s00134-007-0688-x
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发表时间：
2007-09-01
影响因子：
38.9
通讯作者：
Allaouchiche, Bernard
中科院分区：
文献类型：
--
作者：
Boselli, Emmanuel;Breilh, Dominique;Allaouchiche, Bernard
目的：评价微型支气管肺泡灌洗（mini-BAL）与传统支气管镜支气管肺泡灌洗（BAL）测定上皮细胞衬里液（ELF）中妥布霉素浓度的可靠性。设计：前瞻性、开放性研究.背景：一所大学医院的重症监护室和研究病房。患者：12名患有呼吸机相关性肺炎（VAP）的重症成人患者。干预措施：所有受试者均接受妥布霉素7 - 10 mg/ kg静脉输注，每日一次。治疗2天后，通过高效液相色谱法测定妥布霉素的稳态血清和ELF浓度（从BAL和mini-BAL获得）。测量和结果：我们观察到妥布霉素在ELF中的渗透性较差，约为12%，ELF峰浓度约为3 mg/ l。在Bland-Altman分析中观察到两种采样方法之间的良好一致性（平均值+/- SD偏倚= 0.04 +/- 0.38 mg/ l）。结论：我们的研究结果表明，妥布霉素7 - 10 mg/ kg，每日一次，在VAP危重患者中，在难以治疗的病原体的情况下，可能提供不足的肺浓度。此外，与支气管镜BAL相比，微型BAL具有简单、无创和易于在床旁重复的特点，似乎是一种可靠的方法，可用于测定VAP危重患者ELF中抗生素浓度。
Objective: To evaluate the reliability of mini- bronchoalveolar lavage ( mini- BAL) for the measurement of tobramycin concentrations in epithelial lining fluid ( ELF) in comparison with conventional bronchoscopic bronchoalveolar lavage ( BAL). Design: Prospective, open- label study. Setting: An intensive care unit and research ward in a university hospital. Patients: Twelve critically ill adult patients with ventilator- associated pneumonia ( VAP). Interventions: All subjects received intravenous infusions of tobramycin 7 - 10 mg/ kg once daily. After 2 days of therapy, the steady-state serum and ELF concentrations ( obtained from BAL and mini- BAL) of tobramycin were determined by means of high- performance liquid chromatography. Measurements and results: We observed poor penetration of tobramycin in ELF of approximate to 12% with ELF peak concentrations of approximate to 3 mg/ l with both methods. Good agreement in Bland - Altman analysis ( mean +/- SD bias = 0.04 +/- 0.38 mg/ l) was observed between the two methods of sampling. Conclusion: Our results suggest that tobramycin 7 - 10 mg/ kg once daily in critically ill patients with VAP might provide insufficient lung concentrations in the case of difficult- to- treat pathogens. Besides, mini- BAL, which is simple, non- invasive and easily repeatable at the bedside, appears to be a reliable method for the measurement of antibiotic concentrations in ELF in comparison with bronchoscopic BAL in critically ill patients with VAP.