title: Intraoperative vancomycin pharmacokinetics in cardiac surgery with or without cardiopulmonary bypass.
abstract: BACKGROUND
  Vancomycin is administered as antimicrobial prophylaxis to patients undergoing cardiac surgery, an intervention that usually requires cardiopulmonary bypass (CPB). Previous studies reported that CPB modifies vancomycin pharmacokinetic parameters.
  
  
  OBJECTIVE
  To investigate intraoperative vancomycin pharmacokinetic changes in a large population of patients undergoing cardiac surgery with CPB (on-pump) and without CPB (off-pump).
  
  
  METHODS
  In this prospective study, patients undergoing cardiac surgery received a single dose of vancomycin 1000 mg in a 60-minute intravenous infusion, with skin incision performed between 16 and 120 minutes after the end of the infusion. For the on-pump group, arterial samples were drawn before CPB (end of infusion, skin incision), during CPB (5, 30, and 60 minutes, and then every 60 minutes until CPB end), and after CPB (wound closure). For the off-pump group, arterial samples were drawn time-matched to the CPB period of the on-pump group.
  
  
  RESULTS
  Two hundred thirty-six consecutive patients were enrolled: 215 in the on-pump group and 21 in the off-pump group. A total of 1682 serum vancomycin concentrations (median 7/patient) were measured. Vancomycin maximum concentration ([Cmax] on-pump, 45.6 mg/L; off-pump, 47.3 mg/L); area under the concentration-time curve, zero to 8 hours ([AUC0-8] on-pump, 104.6 mg*h/L; off-pump, 96.1 mg*h/L); volume of distribution ([Vd] on-pump, 31 L; off-pump, 28.2 L); and total body clearance ([Cl] on-pump, 6.23 L/h; off-pump, 7.05 L/h) were similar. Moreover, Cmax and AUC0-∞ (AUC, zero to infinity) showed values comparable to those found in previous studies performed on noncardiac surgery patients.
  
  
  CONCLUSIONS
  In our study there were no significant differences in vancomycin Cmax, AUC0-8, Vd, and Cl between the on-pump and off-pump groups. CPB does not seem to significantly modify intraoperative vancomycin pharmacokinetics in patients undergoing cardiac surgery. The results of this study may contribute to increased knowledge of vancomycin pharmacokinetics.
authors.affiliation: Anesthesiology and Intensive Care, Department of Medicine, S. Giovanni Battista Hospital, University of Turin, Turin, Italy. paolo.cotogni@unito.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Cotogni
authors.forename: Roberto
authors.initials: R
authors.lastname: Passera
authors.forename: Cristina
authors.initials: C
authors.lastname: Barbero
authors.forename: Angela
authors.initials: A
authors.lastname: Gariboldi
authors.forename: Donatella
authors.initials: D
authors.lastname: Moscato
authors.forename: Gennaro
authors.initials: G
authors.lastname: Izzo
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics*
chemical_list: D014640:Vancomycin