Antibacterial dosing in intensive care: Pharmacokinetics, degree of disease and pharmacodynamics of sepsis

Treatment of sepsis remains a significant challenge with persisting high mortality and morbidity. Early and appropriate antibacterial therapy remains an important intervention for such patients. To optimise antibacterial therapy, the clinician must possess knowledge of the pharmacokinetic and pharmacodynamic properties of commonly used antibacterials and how these parameters may be affected by the constellation of pathophysiological changes occurring during sepsis. Sepsis, and the treatment thereof, increases renal preload and, via capillary permeability, leads to 'third-spacing', both resulting in higher antibacterial clearances. Alternatively, sepsis can induce multiple organ dysfunction, including renal and/or hepatic dysfunction, causing a decrease in antibacterial clearance. Aminoglycosides are concentration-dependent antibacterials and they display an increased volume of distribution (V-d) in sepsis, resulting in decreased peak serum concentrations. Reduced clearance from renal dysfunction would increase the likelihood of toxicity. Individualised dosing using extended interval dosing, which maximises the peak serum drug concentration (C-max)/minimum inhibitory concentration ratio is recommended. beta-Lactams and carbapenems are time-dependent antibacterials. An increase in Vd and renal clearance will require increased dosing or administration by continuous infusion. If renal impairment occurs a corresponding dose reduction may be required. Vancomycin displays predominantly time-dependent pharmacodynamic properties and probably requires higher than conventionally recommended doses because of an increased V-d and clearance during sepsis without organ dysfunction. However, optimal dosing regimens remain unresolved. The poor penetration of vancomycin into solid organs may require alternative therapies when sepsis involves solid organs (e.g. lung). Ciprofloxacin displays largely concentration-dependent kill characteristics, but also exerts some time-dependent effects. The V-d of ciprofloxacin is not altered with fluid shifts or over time, and thus no alterations of standard doses are required unless renal dysfunction occurs. In order to optimise antibacterial regimens in patients with sepsis, the pathophysiological effects of systemic inflammatory response syndrome need consideration, in conjunction with knowledge of the different kill characteristics of the various antibacterial classes. In conclusion, certain antibacterials can have a very high V-d, therefore leading to a low C-max and if a high peak is needed, then this would lead to underdosing. The Vd of certain antibacterials, namely aminoglycosides and vancomycin, changes over time, which means dosing may need to be altered over time. Some patients with serum creatinine values within the normal range can have very high drug clearances, thereby producing low serum drug levels and again leading to underdosing. Copyright © 2010 Elsevier Inc. All rights reserved.

A unique behavior of sub-critical hydrocarbon permeability in activated carbon at low pressures

In our study on sub-critical hydrocarbon permeation in activated carbon, a minimum in the total permeability (B-T) at low pressure has been observed for only long-chain hydrocarbons such as n-hexane and n-heptane. Such an observation suggests that the minimum appearance depends on the properties of permeating vapors as well as the porous medium. In this paper a permeation model is presented to explain the minimum behavior with the allowance of the collision-reflection factor in the Knudsen diffusivity to be a function of surface loading. Surface diffusion was found to be very significant compared to other transport mechanisms such as Knudsen diffusion and gaseous viscous flow at low pressures. Since the gaseous viscous flow contributes negligibly to the B, at low pressures, the minimum appearance in the B, is mainly attributed to the interplay between Knudsen diffusion and surface diffusion. Also, the molecular structure of adsorbates plays an important role in the minimum appearance.

Capillary jet instability under the influence of gravity

The focus of this paper is on the effect of gravity stretching on disturbed capillary jet instability. Break-up and droplet formation under low flows are simulated using finite difference solution of a one-dimensional approximation of disturbed capillary jet instability chosen from the work by Eggers and Dupont (J. Fluid Mech. 155 (1994) 289). Experiments were conducted using water and aqueous glycerol solutions to compare with simulations. We use a gravity parameter, G, which quantifies gravity stretching by relating flow velocity, orifice size and acceleration and is the reciprocal of the Fronde number. The optimum disturbance frequency Omega(opt) was found to be inversely proportional to G. However, this relationship appears to be complex for the range of G's investigated. At low G, the relationship between Omega(opt) and G appears to be linear but takes on a weakly decaying like trend as G increases. As flows are lowered, the satellite-free regime decreases, although experimental observation found that merging of main and satellite drops sometimes offset this effect to result in monodispersed droplet trains post break-up. Viscosity did not significantly affect the relationship between the disturbance frequency and G, although satellite drops could be seen more clearly close to the upper limit for instability at high G's. It is possible to define regimes of satellite formation under low flows by considering local wavenumbers at the point of instability. (C) 2004 Elsevier Ltd. All rights reserved.

Determination of protein charge by capillary zone electrophoresis

The feasibility of employing classical electrophoresis theory to determine the net charge (valence) of proteins by capillary zone electrophoresis is illustrated in this paper. An outline of a procedure to facilitate the interpretation of mobility measurements is demonstrated by its application to a published mobility measurement for Staphylococcal nuclease at pH 8.9 that had been obtained by capillary zone electrophoresis. The significantly higher valence of +7.5 (cf. 5.6 from the same series of measurements) that has been reported on the basis of a charge ladder approach for charge determination signifies the likelihood that the latter generic approach may be prone to error arising from nonconformity of the experimental system with an inherent assumption that chemical modification or mutation of amino acid residues has no effect on the overall three-dimensional size and shape of the protein. (C) 2004 Elsevier Inc. All rights reserved.

Permeability studies of alkylamides and caffeic acid conjugates from echinacea using a Caco-2 cell monolayer model

Background: Echinacea is composed of three major groups of compounds that are thought to be responsible for stimulation of the immune system-the caffeic acid conjugates, alkylamides and polysaccharides. This study has focussed on the former two classes, as these are the constituents found in ethanolic liquid extracts. Objective: To investigate the absorption of these two groups of compounds using Caco-2 monolayers, which are a model of the intestinal epithelial barrier. Results: The caffeic acid conjugates (caftaric acid, echinacoside and cichoric acid) permeated poorly through the Caco-2 monolayers although one potential metabolite, cinnamic acid, diffused readily with an apparent permeability (P-app) of 1x10(-4) cm/s. Alkylamides were found to diffuse through Caco-2 monolayers with P-app ranging from 3x10(-6) to 3x10(-4) cm/s. This diversity in P-app for the different alkylamides correlates to structural variations, with saturation and N-terminal methylation contributing to decreases in P-app. The transport of the alkylamides is not affected by the presence of other constituents and the results for synthetic alkylamides were in line with those for the alkylamides in the echinacea preparation. Conclusion: Alkylamides but not caffeic acid conjugates are likely to cross the intestinal barrier.

A comparison between capillary and imaging techniques for sizing bubbles in flotation systems

This communication reports a laboratory and plant comparison between the University of Cape Town (UCT) device (capillary) and the McGill University bubble sizing method (imaging). The laboratory work was conducted on single bubbles to establish the accuracy of the techniques by comparing with a reference method (capture in a burette). Single bubble measurements with the McGill University technique showed a tendency to slightly underestimate (4% for a 1.3 mm bubble) and the UCT technique to slightly overestimate (1% for the 1.3 man bubble). Both trends are anticipated from fundamental considerations. In the UCT technique bubble breakup was observed when measuring a 2.7 mm bubble using a 0.5 mm ID capillary tube. A discrepancy of 11% was determined when comparing the techniques in an industrial-scale mechanical flotation cell. The possible sources of bias are discussed. (C) 2003 Elsevier Ltd. All rights reserved.

A new equation for macroscopic description of capillary rise in porous media

Capillary rise in porous media is frequently modeled using the Washburn equation. Recent accurate measurements of advancing fronts clearly illustrate its failure to describe the phenomenon in the long term. The observed underprediction of the position of the front is due to the neglect of dynamic saturation gradients implicit in the formulation of the Washburn equation. We consider an approximate solution of the governing macroscopic equation, which retains these gradients, and derive new analytical formulae for the position of the advancing front, its speed of propagation, and the cumulative uptake. The new solution properly describes the capillary rise in the long term, while the Washburn equation may be recovered as a special case. (C) 2004 Elsevier Inc. All rights reserved.

Application of density functional theory to capillary phenomena in cylindrical mesopores with radial and longitudinal density distributions

In this paper, we applied a version of the nonlocal density functional theory (NLDFT) accounting radial and longitudinal density distributions to study the adsorption and desorption of argon in finite as well as infinite cylindrical nanopores at 87.3 K. Features that have not been observed before with one-dimensional NLDFT are observed in the analysis of an inhomogeneous fluid along the axis of a finite cylindrical pore using the two-dimensional version of the NLDFT. The phase transition in pore is not strictly vapor-liquid transition as assumed and observed in the conventional version, but rather it exhibits a much elaborated feature with phase transition being complicated by the formation of solid phase. Depending on the pore size, there are more than one phase transition in the adsorption-desorption isotherm. The solid formation in finite pore has been found to be initiated by the presence of the meniscus. Details of the analysis of the extended version of NLDFT will be discussed in the paper. (C) 2004 American Institute of Physics.

Capillary phenomena in the framework of the two-dimensional density functional theory

We present results of application of the density functional theory (DFT) to adsorption and desorption in finite and infinite cylindrical pores accounting for the density distribution in radial and axial directions. Capillary condensation via formation of bridges is considered using canonical and grand canonical versions of the 2D DFT. The potential barrier of nucleation is determined as a function of the bulk pressure and the pore diameter. In the framework of the conventional assumptions on intermolecular interactions both 1D and 2D DFT versions lead to the same results and confirm the classical scenario of condensation and evaporation: the condensation occurs at the vapor-like spinodal point, and the evaporation corresponds to the equilibrium transition pressure. The analysis of experimental data on argon and nitrogen adsorption on MCM-41 samples seems to not completely corroborate this scenario, with adsorption branch being better described by the equilibrium pressure - diameter dependence. This points to the necessity of the further development of basic representations on the hysteresis phenomena.

Capillary break-up rheometry of low-viscosity elastic fluids

We investigate the dynamics of the capillary thinning and break-up process for low viscosity elastic fluids such as dilute polymer solutions. Standard measurements of the evolution of the midpoint diameter of the necking fluid filament are augmented by high speed digital video images of the break up dynamics. We show that the successful operation of a capillary thinning device is governed by three important time scales (which characterize the relative importance of inertial, viscous and elastic processes), and also by two important length scales (which specify the initial sample size and the total stretch imposed on the sample). By optimizing the ranges of these geometric parameters, we are able to measure characteristic time scales for tensile stress growth as small as 1 millisecond for a number of model dilute and semi-dilute solutions of polyethylene oxide (PEO) in water and glycerol. If the final aspect ratio of the sample is too small, or the total axial stretch is too great, measurements are limited, respectively, by inertial oscillations of the liquid bridge or by the development of the well-known beads-on-a-string morphology which disrupt the formation of a uniform necking filament. By considering the magnitudes of the natural time scales associated with viscous flow, elastic stress growth and inertial oscillations it is possible to construct an operability diagram characterizing successful operation of a capillary break-up extensional rheometer. For Newtonian fluids, viscosities greater than approximately 70 mPas are required; however for dilute solutions of high molecular weight polymer, the minimum Viscosity is substantially lower due to the additional elastic stresses arising from molecular extension. For PEO of molecular weight 2.10(6) g/mol, it is possible to measure relaxation times of order 1 ms in dilute polymer solutions with zero-shear-rate viscosities on the order of 2-10 mPas.

Improvement of the Derjaguin-Broekhoff-de Boer theory for capillary condensation/evaporation of nitrogen in mesoporous systems and its implications for pore size analysis of MCM-41 silicas and related materials

In this work, we propose an improvement of the classical Derjaguin-Broekhoff-de Boer (DBdB) theory for capillary condensation/evaporation in mesoporous systems. The primary idea of this improvement is to employ the Gibbs-Tolman-Koenig-Buff equation to predict the surface tension changes in mesopores. In addition, the statistical film thickness (so-called t-curve) evaluated accurately on the basis of the adsorption isotherms measured for the MCM-41 materials is used instead of the originally proposed t-curve (to take into account the excess of the chemical potential due to the surface forces). It is shown that the aforementioned modifications of the original DBdB theory have significant implications for the pore size analysis of mesoporous solids. To verify our improvement of the DBdB pore size analysis method (IDBdB), a series of the calcined MCM-41 samples, which are well-defined materials with hexagonally ordered cylindrical mesopores, were used for the evaluation of the pore size distributions. The correlation of the IDBdB method with the empirically calibrated Kruk-Jaroniec-Sayari (KJS) relationship is very good in the range of small mesopores. So, a major advantage of the IDBdB method is its applicability for small mesopores as well as for the mesopore range beyond that established by the KJS calibration, i.e., for mesopore radii greater than similar to4.5 nm. The comparison of the IDBdB results with experimental data reported by Kruk and Jaroniec for capillary condensation/evaporation as well as with the results from nonlocal density functional theory developed by Neimark et al. clearly justifies our approach. Note that the proposed improvement of the classical DBdB method preserves its original simplicity and simultaneously ensures a significant improvement of the pore size analysis, which is confirmed by the independent estimation of the mean pore size by the powder X-ray diffraction method.

Permeability of subcritical hydrocarbons in activated carbon

A new diffusion and flow model is presented to describe the behavior of hydrocarbon vapors in activated carbon. The micro/mesopore size distribution (PSD) is obtained according to Do's method which consists of two sequential processes of pore layering and pore filling. This model uses the micro/meso PSD obtained from each adsorbate equilibrium isotherm, which reflects the dynamics behavior of adsorbing molecules through the solid. The initial rise in total permeability is mainly attributed to adsorbed-phase diffusion (that is, surface diffusion), whereas the decrease over reduced pressure of about 0.9 is attributed to the reduction of pore space available for gas phase diffusion and flow. A functional form of surface diffusivity is proposed and validated with experimental data. This model predicts well the permeability of condensable hydrocarbon vapors in activated carbon. (C) 2005 American Institute of Chemical Engineers.

Aeration for plant root respiration in a tidal marsh

This paper investigates the tidal effects on aeration conditions for plant root respiration in a tidal marsh. We extend the work of Ursino et al. ( 2004) by using a two-phase model for air and water flows in the marsh. Simulations have been conducted to examine directly the link between the airflow dynamics and the aeration condition in the marsh soil. The results show that the effects of entrapped air on water movement in the vadose zone are significant in certain circumstances. Single-phase models based on Richards' equation, which neglect such effects, may not be adequate for quantifying the aeration condition in tidal marsh. The optimal aeration condition, represented by the maximum of the integral magnitude of tidally advected air mass ( TAAM) flux, is found to occur near the tidal creek for the four soil textures simulated. This may explain the observation that some salt marsh plant species grow better near tidal creeks than in the inner marsh areas. Our analyses, based on the two-phase model and predicted TAAM flux magnitude, provide further insight into the positive feedback'' mechanism proposed by Ursino et al. ( 2004). That is, pioneer plants may grow successfully near the creek where the root aeration condition is optimal. The roots of the pioneer plants can soften and loosen the rhizosphere soil, which increases the evapotranspiration rate, the soil porosity, and absolute permeability and weakens the capillary effects. These, in turn, improve further the root aeration conditions and may lead to colonization by plants less resistant to anaerobic conditions.