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Closed-loop control of continuous piperacillin delivery: An in silico study
oleh: Pau Herrero, Pau Herrero, Richard C. Wilson, Richard C. Wilson, Ryan Armiger, Ryan Armiger, Jason A. Roberts, Jason A. Roberts, Jason A. Roberts, Jason A. Roberts, Alison Holmes, Alison Holmes, Pantelis Georgiou, Pantelis Georgiou, Timothy M. Rawson, Timothy M. Rawson
Format: | Article |
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Diterbitkan: | Frontiers Media S.A. 2022-10-01 |
Deskripsi
Background and objective: Sub-therapeutic dosing of piperacillin-tazobactam in critically-ill patients is associated with poor clinical outcomes and may promote the emergence of drug-resistant infections. In this paper, an in silico investigation of whether closed-loop control can improve pharmacokinetic-pharmacodynamic (PK-PD) target attainment is described.Method: An in silico platform was developed using PK data from 20 critically-ill patients receiving piperacillin-tazobactam where serum and tissue interstitial fluid (ISF) PK were defined. Intra-day variability on renal clearance, ISF sensor error, and infusion constraints were taken into account. Proportional-integral-derivative (PID) control was selected for drug delivery modulation. Dose adjustment was made based on ISF sensor data with a 30-min sampling period, targeting a serum piperacillin concentration between 32 and 64 mg/L. A single tuning parameter set was employed across the virtual population. The PID controller was compared to standard therapy, including bolus and continuous infusion of piperacillin-tazobactam.Results: Despite significant inter-subject and simulated intra-day PK variability and sensor error, PID demonstrated a significant improvement in target attainment compared to traditional bolus and continuous infusion approaches.Conclusion: A PID controller driven by ISF drug concentration measurements has the potential to precisely deliver piperacillin-tazobactam in critically-ill patients undergoing treatment for sepsis.