title: Physiologic response of stress and aminoglycoside clearance in critically ill patients.
abstract: OBJECTIVE
  To examine the relationships between aminoglycoside clearance and physiologic parameters associated with the physiologic response to injury.
  
  
  METHODS
  Cross-sectional study of surgical patients receiving aminoglycoside pharmacokinetic monitoring and parenteral nutritional support.
  
  
  METHODS
  An adult surgical ICU.
  
  
  METHODS
  Fifty-four surgical/trauma patients who had Gram-negative sepsis.
  
  
  METHODS
  Measurements of the physiologic stress response to injury were associated with aminoglycoside clearance in 54 surgical/trauma patients who had Gram-negative sepsis. Measurements used to estimate the magnitude of the stress response included a 24-hr urinary urea nitrogen excretion, blood urea nitrogen, peak temperature, serum albumin, bilirubin, and transferrin concentrations.
  
  
  RESULTS
  Mean drug clearance rate (4.4 +/- 2.5 [SD] L/hr) was related to the physiologic measurements using correlation and regression techniques. Collectively, all physiologic indices (utilized) explained 59% of the variance in drug clearance (p < .001), an amount similar to the variance explained by creatinine clearance alone (53%). When all six physiologic measurements were included into a multiple regression model that included creatinine clearance, the total variance explained increased to 73%.
  
  
  CONCLUSIONS
  Along with renal function estimates, the physiologic response to stress should be considered when treating critically ill patients with aminoglycosides and other, similar, renally eliminated drugs.
authors.affiliation: Section of Clinical Pharmacy, St. Paul-Ramsey Medical Center, MN 55101.
authors.forename: D A
authors.initials: DA
authors.lastname: Tholl
authors.forename: L R
authors.initials: LR
authors.lastname: Shikuma
authors.forename: T Q
authors.initials: TQ
authors.lastname: Miller
authors.forename: J M
authors.initials: JM
authors.lastname: Woodward
authors.forename: F B
authors.initials: FB
authors.lastname: Cerra
authors.forename: D E
authors.initials: DE
authors.lastname: Zaske
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000493:pharmacokinetics*; D001806:Blood Urea Nitrogen; D003430:Cross-Sectional Studies; D005260:Female; D005839:Gentamicins / Q000493:pharmacokinetics / Q000627:therapeutic use; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000378:metabolism* / Q000503:physiopathology; D006801:Humans; D007362:Intensive Care Units; D007668:Kidney / Q000378:metabolism; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D010288:Parenteral Nutrition; D013312:Stress, Physiological / Q000378:metabolism*; D014947:Wounds and Injuries / Q000378:metabolism* / Q000503:physiopathology
chemical_list: D000617:Aminoglycosides; D005839:Gentamicins