title: Pilot study on the influence of liver blood flow and cardiac output on the clearance of propofol in critically ill patients.
abstract: OBJECTIVE
  To investigate the effect of cardiac output and liver blood flow on propofol concentrations in critically ill patients in the intensive care unit.
  
  
  METHODS
  Five medical/surgical critically ill patients were enrolled in this preliminary study. Liver blood flow was measured using sorbitol. The cardiac output was measured by bolus thermodilution. NONMEM ver. V was applied for propofol pharmacokinetic analysis.
  
  
  RESULTS
  The clearance of propofol was positively influenced by the liver blood flow (P < 0.005), whereas no significant correlation between cardiac output and propofol clearance was found. A correlation between liver blood flow and cardiac output or cardiac index could not be assumed in this patient group.
  
  
  CONCLUSIONS
  Liver blood flow is a more predictive indicator than cardiac output for propofol clearance in critically ill patients when the techniques of hepatic sorbitol clearance and bolus thermodilution, respectively, are used. Further study is needed to determine the role played by liver blood flow and cardiac output on the pharmacokinetics of highly extracted drugs in order to reduce the observed high interindividual variabilities in response in critically ill patients.
authors.affiliation: Department of Clinical Pharmacy, St. Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands.
authors.forename: Mariska Y M
authors.initials: MY
authors.lastname: Peeters
authors.forename: Leon P H J
authors.initials: LP
authors.lastname: Aarts
authors.forename: Ferenc A
authors.initials: FA
authors.lastname: Boom
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Bras
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Meindert
authors.initials: M
authors.lastname: Danhof
authors.forename: Catherijne A J
authors.initials: CA
authors.lastname: Knibbe
mesh_terms: D000368:Aged; D000777:Anesthetics / Q000493:pharmacokinetics*; D002302:Cardiac Output; D016638:Critical Illness; D005260:Female; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D017711:Nonlinear Dynamics; D010865:Pilot Projects; D015742:Propofol / Q000493:pharmacokinetics*; D012984:Software; D013012:Sorbitol / Q000493:pharmacokinetics; D013815:Thermodilution
chemical_list: D000777:Anesthetics; D013012:Sorbitol; D015742:Propofol