Interestingly, these plots clearly show that the amplitude of HR or MAP increase following various Ep infusion rates is related to the childs BW, that is, the lower the BW, the smaller the amplitude CB-7598 of increase. Limitations of the study The small sample size likely limited the identification of other significant covariates that could affect either the pharmacokinetics or the responses to Ep. We were not able to evidence a hemodynamic effect of milrinone in the model. however, we cannot ignore the potential ef fect of the latter and must assume that the modeling of the hemodynamic effects of Ep, including its simula tions, implicitly take into account the effects of milri none. Furthermore, such simulations need to be confirmed in a future clinical study.

Finally, as only children who underwent an open heart surgery with CPB were included, our results cannot be easily Inhibitors,Modulators,Libraries extended to patients with other circulatory failure etiologies. Conclusion This original study on pharmacokinetics, hemodynamic and metabolic effects of Ep to prevent postoperative LCOS in children highlights as expected, clear between subject variability related to the substantial role of age and BW. Taking into account these individual character istics should help clinicians in determining an appropri ate a priori dosing regimen. Key messages In critically ill cardiac postoperative children, lower bodyweight was associated with lower epinephrine clearance. Differences of hemodynamic responses to epinephrine were related to age and bodyweight the lower the bodyweight, the smaller the amplitude of heart rate and mean arterial pressure increase.

Increase of plasma glucose and lactate levels was related to epinephrine concentration without any effect of age, bodyweight or exogenous glucose supply. Epinephrine dosing simulations should help the clinician Inhibitors,Modulators,Libraries in determining an appropriate a priori dosing regimen. Introduction Glutamine depletion as indicated by a low plasma glutam Inhibitors,Modulators,Libraries ine concentration at ICU admittance is an independent predictor of an unfavorable outcome. Inhibitors,Modulators,Libraries Exogenous glutamine supplementation is the standard of care when parenteral nutrition is required in critically ill patients. Advantages in terms of mortality and morbidity have been demonstrated when the exogenously supplemented glutamine is administered intravenously.

In a recent study, however, harm was reported when pharmacological doses Inhibitors,Modulators,Libraries of glutamine were administered to critically ill patients combined with hypocaloric feeding. The ex istence of conflicting clinical data is a strong argument to systematically elucidate how exogenous glutamine supplementation is handled, in particular the relation between plasma concentrations new product and the endogenous glutamine production. Glutamine rate of appearance may be used as an estimate of endogenous glutamine production. There are several ways to measure and calculate glutamine Ra.