Pentobarbital Removal During Continuous Venovenous Hemofiltration: Case Report and Review of the Literature:

Background:Renal replacement therapy may enhance the elimination of barbiturates. Pentobarbital clearance during continuous venovenous hemofiltration (CVVH) has not been described previously. We report a patient case involving the measurement of serial pentobarbital levels during CVVH and review relevant literature characterizing extracorporeal pentobarbital elimination.Methods:The following is a retrospective report of a previously healthy 26-year-old woman who sustained a severe traumatic brain injury (TBI) and required administration of pentobarbital on hospital day 0 for intracranial pressure (ICP) control. Given concern for interference with the patient’s ongoing neurologic assessments, pentobarbital was discontinued on hospital day 4. The patient’s hospital course was complicated by acute kidney injury (AKI), requiring initiation of CVVH on hospital day 5. Daily serum pentobarbital levels were obtained during CVVH.Results:While on CVVH, the patient’s estimated pentobarbital clearance ranged from 6 t...