RESUMEN
OBJECTIVES: Vancomycin is used to treat Gram-positive infections in critically ill adults. For vancomycin administered by continuous infusion (CI), various target ranges have been used, ranging from 15-20 mg/L to 30-40 mg/L. This systematic literature review was conducted to investigate the impact of steady-state serum concentration (Css) of CI on safety and efficacy of therapy in critically ill adults. METHODS: Relevant literature was identified by searching two electronic databases (PubMed, Cochrane Library) and Google Scholar from inception until July 2023, focusing on studies reporting measured Css and treatment outcomes (e.g. mortality, nephrotoxicity) with CI. Due to study heterogeneity, a narrative synthesis of the evidence was performed. RESULTS: Twenty-one publications were included with a total of 2949 patients. Mortality was higher (two studies, n = 388 patients) and clinical cure was lower (one study, n = 40 patients) with Css < 15 mg/L measured 24 h after initiation of CI (C24). An adequate loading dose appeared most important for maintaining higher C24. Generally, higher Css was associated with higher rates of acute kidney injury (AKI) (15 studies, n = 2331 patients). It was calculated that Css < 25 mg/L (versus ≥25 mg/L) was preferable for reducing nephrotoxicity (three studies, n = 515 patients). CONCLUSIONS: Despite sparse data availability, the target range of 15-25 mg/L in CI may increase clinical cure and reduce mortality and AKI. In future research, vancomycin Css cohorts should be formed to allow evaluation of the impact of Css of CI on treatment outcomes.
Asunto(s)
Lesión Renal Aguda , Vancomicina , Humanos , Adulto , Vancomicina/efectos adversos , Antibacterianos/efectos adversos , Enfermedad Crítica , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/tratamiento farmacológico , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
A three-dimensional model that predicts the interface morphologies of silicon thin-film solar cells prepared on randomly textured substrates was developed and compared to experimental data. The surface morphologies of silicon solar cells were calculated by using atomic force microscope scans of the textured substrates and the film thickness as input data. Calculated surface morphologies of silicon solar cells are in good agreement with experimentally measured morphologies. A detailed description of the solar cell interface morphologies is necessary to understand light-trapping in silicon single junction and micromorph tandem thin-film solar cells and derive optimal light-trapping structures.