Phân tích kết quả hiệu chỉnh liều vancomycin thông qua giám sát nồng độ thuốc trong máu trên bệnh nhân hồi sức tích cực: Kết quả bước đầu tại Bệnh viện Thanh Nhàn

Abstract

Objective: To analyze the results of implementing vancomycin dose adjustment according to the therapeutic drug monitoring (TDM) protocol in intensive care unit patients (ICU) by the AUC estimated by Bayesian method (applies to intermittent intravenous infusion) and target concentration (applies to continuous intravenous infusion). Subject and method: In an interventional prospective study on 80 patients using vancomycin, data were collected daily through clinical practices of clinical pharmacists, doctors and nurses at the ICU Thanh Nhan Hospital from April to June 2023. The AUC was estimated by Bayesian method with SmartdoseAI software based on vancomycin concentration in the blood. In the patients with intermittent intravenous infusion, the vancomycin dose was adjusted to achieve a target AUC of 400-600 mg·h/L. In the patients with continuous intravenous infusion, the vancomycin dose was adjusted to achieve a target concentration of 20-30 mg/L. Result: The percentage of patients receiving the appropriate loading and maintenance dose regimens according to the guidelines were 75% and 88%. However, the percentage of patients achieving the target concentrations for intermittent and continuous intravenous vancomycin was relatively low, at 36.2% and 44.4%. After adjusting dose regimens, the rate of achieving pharmacokinetic/pharmacodynamic (PK/PD) target increased in the two patient groups to 64.5% and 50%. Conclusion: Vancomycin dose optimization using TDM increased the attainment of the AUC target, the estimate AUC by Bayesian method was convenient and suitable for clinical practice on ICU patients. Further optimization of the initial dose regimen is needed to achieve the vancomycin target concentration early.