RESUMEN
OBJECTIVES: To determine the relationship between theophylline trough levels and urine output in critically ill children administered aminophylline as adjunctive diuretic therapy. DESIGN: Retrospective cohort study. SETTING: The PICU of a tertiary care children's hospital. PATIENTS: A mixed population of medical/surgical including postoperative cardiothoracic surgery patients less than 18 years old. INTERVENTIONS: Electronic medical records of all PICU patients admitted from July 2010 to June 2015 were reviewed, and patients who received aminophylline as diuretic therapy were identified. MEASUREMENTS AND MAIN RESULTS: Patient cohort data including demographics, daily aminophylline, furosemide and chlorothiazide dosing, theophylline trough levels, fluid intake, urine output and total fluid balance, blood urea nitrogen, and creatinine levels were abstracted. Multivariate analysis based on a generalized estimating equations approach demonstrated that aminophylline administration, when analyzed as a categorical variable, was associated with an increase in urine output and decreased fluid balance. However, aminophylline dosing, when analyzed as a continuous variable, was associated with neither an increase in urine output nor decreased fluid balance. Theophylline trough levels were not correlated with urine output at 24 hours (p = 0.78) and were negatively correlated with urine output at 48 hours (r = 0.078; p < 0.005). CONCLUSIONS: Aminophylline administration provided a measure of increased diuresis, regardless of dosage, and theophylline trough levels. Therefore, achieving a prescribed therapeutic trough level may not be necessary for full diuretic effect. Because, as opposed to the diuretic effect, the side effect profile of aminophylline is dose-dependent, low maintenance dosing may optimize the balance between providing adjunctive diuretic effect while minimizing the risk of toxicity.
Asunto(s)
Aminofilina/administración & dosificación , Diuréticos/administración & dosificación , Fluidoterapia/métodos , Equilibrio Hidroelectrolítico/efectos de los fármacos , Administración Intravenosa , Aminofilina/sangre , Aminofilina/farmacocinética , Niño , Preescolar , Enfermedad Crítica , Diuréticos/sangre , Diuréticos/farmacocinética , Femenino , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Masculino , Análisis de Regresión , Estudios RetrospectivosRESUMEN
OBJECTIVE: This study investigated whether aminophylline has an acute effect on the muscle performance of patients with amyotrophic lateral sclerosis (ALS). The study was a randomized, double-blind, crossover against placebo. MATERIALS AND METHODS: Twenty-five patients (48.5 +/- 14.1 years) with ALS were evaluated by means of forced vital capacity (FVC), maximal mouth inspiratory and expiratory pressures (P(Imax)/P(Emax)) and endurance, maximum voluntary ventilation (MVV) and handgrip strength (HS); variables were measured before and after the patients received an intravenous infusion of aminophylline or placebo. RESULTS: MVV (P<0.02) and HS of the right and left hands (P=0.05) increased after aminophylline infusion. There was a positive correlation between FVC and P(Imax) (r=0.80; P<0.05); between MVV and P(Imax) post-aminophylline, respectively (r=0.77; P<0.05). Serum aminophylline levels ranged from 5.3 to 10.5 microg/mL (mean 7.30). CONCLUSION: The acute administration of aminophylline improves the endurance of respiratory muscles and increases handgrip strength in patients with ALS.
Asunto(s)
Aminofilina/administración & dosificación , Esclerosis Amiotrófica Lateral/complicaciones , Broncodilatadores/administración & dosificación , Insuficiencia Respiratoria/tratamiento farmacológico , Adulto , Aminofilina/sangre , Broncodilatadores/sangre , Estudios Cruzados , Femenino , Fuerza de la Mano , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Fuerza Muscular/efectos de los fármacos , Insuficiencia Respiratoria/etiología , Músculos Respiratorios/efectos de los fármacos , Músculos Respiratorios/fisiología , Resultado del Tratamiento , Capacidad Vital/efectos de los fármacosRESUMEN
The oral dosage of aminophylline required for therapeutic "trough" serum theophylline levels was studied in 150 children, 16 months to 19 years old (mean 8.28 years). Dosage requirements tended to be higher for children under 10 years, but marked person-to-person variability in the relation of dose to serum level was seen at all ages. Individual patients generally maintained consistent serum levels when receiving unchanging doses, although intercurrent disease sometimes disrupted this relationship. Individualization of oral dosage based on frequent serum measurements is necessary to maintain theophylline levels in the therapeutic range and to avoid toxicity.