--- title: "Improving Vancomycin Dosing in Pediatric Subpopulations (Part I): Guiding Model Selection in CVICU Patients" description: InsightRX launches a new vancomycin CRRT model, enhancing precision dosing for hemodialysis patients, and sets a new standard in individualized medicine. image: https://blog.insight-rx.com/hubfs/pediatric-model-refit-CVICU-patients.png --- [![InsightRX](https://blog.insight-rx.com/hubfs/insightrx_logo_white-teal.svg)](https://blog.insight-rx.com/) - For Providers - Solutions - [MIPD for Providers Explore our full solution for Bayesian model-informed dosing](https://www.insight-rx.com/mipd) - [Future of Pharmacy Learn what's next for AI in health tech, and why architecture matters](https://www.insight-rx.com/future) - Products - [InsightRX Nova Bayesian dosing (MIPD) app for bedside clinical decision support](https://www.insight-rx.com/provider/nova) - [InsightRX Apollo Real-time clinical analytics to measure outcomes](https://www.insight-rx.com/provider/apollo) - [Drug Modules Available medications for precision dosing apps](https://www.insight-rx.com/provider/drug-modules) - [For Life Sciences](https://www.insight-rx.com/life-sciences) - Overview - [InsightRX for Life Sciences Explore our solution for biopharma and clinical trial use](https://www.insight-rx.com/life-sciences) - Products - [Nova for Life Sciences Precision dosing app for clinical trial use](https://www.insight-rx.com/life-sciences/nova) - [Astra for Life Sciences AI-native environment for PK/PD modeling and simulation](https://www.insight-rx.com/life-sciences/astra) - Platform - [Continuous Learning Patented process for model retraining and improvement](https://www.insight-rx.com/platform/continuous-learning) - [Integrations Platform interoperability setup with EHRs, EDCs, and more](https://www.insight-rx.com/platform/integrations) - [Security & Regulatory Standards for product development and release](https://www.insight-rx.com/platform/security-regulatory) - [Success & Support Pharmacist-led training, onboarding, and education](https://www.insight-rx.com/platform/support) - Resources - Science - [Data Science Explore the science and learn more about our R&D](https://www.insight-rx.com/data-science) - [Scientific Publications Impactful research manuscripts with at least one InsightRX author](https://www.insight-rx.com/data-science/scientific-publications) - [How to Cite Using one of our apps? 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View available openings here](https://www.insight-rx.com/careers) - [Customers Hear what others have to say about their experience](https://www.insight-rx.com/customers) - Press - [All Stories InsightRX news, company updates, and more](https://blog.insight-rx.com/press-releases) - [Press Releases Announcements for events, partnerships, and company updates](https://blog.insight-rx.com/press-releases?section=press_releases) - [Media InsightRX in the news — digital, print, podcasts, and other outlets](https://blog.insight-rx.com/press-releases?section=media) [![Contact Us](https://no-cache.hubspot.com/cta/default/40041574/interactive-193831493462.png)](https://cta-service-cms2.hubspot.com/web-interactives/public/v1/track/redirect?encryptedPayload=AVxigLIVhNAV4frdGw7WK4%2FsUL9BSW7sTFfaUWeB6c0miW6Ak22RBUNE5R8BeaQrWqzDSork53FkrNEqiSn%2FTM4f%2BVzPNcA0Ikxp7y6GqZRUQJ2HulFNF849cXXSebQBDVQXFR3hVvn8tZ3jkxYoygqRgjFUwIOapgI0FM8UFCm2xhxz2SgLhEGqk1U%3D&webInteractiveContentId=193831493462&portalId=40041574) [![Contact Us](https://no-cache.hubspot.com/cta/default/40041574/interactive-193831493462.png)](https://cta-service-cms2.hubspot.com/web-interactives/public/v1/track/redirect?encryptedPayload=AVxigLIVhNAV4frdGw7WK4%2FsUL9BSW7sTFfaUWeB6c0miW6Ak22RBUNE5R8BeaQrWqzDSork53FkrNEqiSn%2FTM4f%2BVzPNcA0Ikxp7y6GqZRUQJ2HulFNF849cXXSebQBDVQXFR3hVvn8tZ3jkxYoygqRgjFUwIOapgI0FM8UFCm2xhxz2SgLhEGqk1U%3D&webInteractiveContentId=193831493462&portalId=40041574) Product Innovation # Improving Vancomycin Dosing in Pediatric Subpopulations (Part I): Guiding Model Selection in CVICU Patients - Published July 30, 2025 By [Michael McCarthy](https://blog.insight-rx.com/resources/author/michael-mccarthy) ![](https://blog.insight-rx.com/hubfs/pediatric-model-refit-CVICU-patients.png) ## Why Pediatric CVICU Patients Require Specialized Dosing Models Selecting a suitably predictive pharmacokinetic (PK) model for model-informed precision dosing (MIPD) of vancomycin is uniquely challenging in special subpopulations like **pediatric cardiovascular intensive care unit (CVICU) patients**. In addition to challenges associated with age-dependent maturation seen across all pediatric populations, CVICU patients often display significantly altered PK compared to the general pediatric population. Volume of distribution (Vd) and drug clearance (CL) may be altered due to post-surgical fluid shifts, the use of co-medications or co-therapies, and other intensive interventions. To address these complexities and improve vancomycin dose-optimization, researchers have developed several specialized PK models that aim to capture the altered PK of pediatric CVICU patients better than general population models. ## Our Approach: Evaluating PK Models in Real-World Pediatric CVICU Data At InsightRX, we [continuously review, validate, and improve the models](https://blog.insight-rx.com/resources/insightrx-nova-pk-model-selection-process) used in [InsightRX Nova](https://www.insight-rx.com/provider/nova) to reflect the diversity and complexity of your patient populations. In this project, our Data Science team: - Analyzed 219 pediatric CVICU patients receiving vancomycin across 11 clinical sites - [Evaluated and compared the predictive performance](https://blog.insight-rx.com/resources/pharmacokinetic-model-comparisons-methods) of three specialized CVICU models and two frequently well-performing general population models - Used [root mean square error (RMSE), mean percentage error (MPE), and accuracy](https://blog.insight-rx.com/resources/pharmacokinetic-model-comparisons-methods) as primary metrics - Applied our [continuous learning framework](https://blog.insight-rx.com/resources/continuous-learning-model-informed-precision-dosing-pediatric-vancomycin) to refit the best-performing models’ parameter estimates on real-world data—to see if predictive performance could be further improved ## Which Models Performed Best? Among the published population PK models, we found that: - All three CVICU-supporting models ([Kamp 2024](https://doi.org/10.1007/s40262-024-01463-3), [Moffett 2019](https://doi.org/10.5863/1551-6776-24.2.107), [Shimamoto 2023](https://doi.org/10.1002/cpt.3095)) outperformed general population models ([Colin 2019](https://doi.org/10.1007/s40262-018-0727-5), [Le 2014](https://doi.org/10.1097/FTD.0000000000000039)) - The [Moffett 2019](https://doi.org/10.5863/1551-6776-24.2.107) and [Shimamoto 2023](https://doi.org/10.1002/cpt.3095) models performed best overall After applying our continuous learning framework: - We were able to further improve both models - The refit Shimamoto 2023 model delivered the best overall performance across *a priori* predictions (where predictions are made using population PK parameters) and *a posteriori* predictions ([where PK parameter estimates are tailored to an individual patient using therapeutic drug monitoring samples and Bayesian estimation](https://blog.insight-rx.com/resources/introduction-mipd-bayesian-pharmacy)) This well-performing, refit model is now available in InsightRX Nova for all customers using the pediatric vancomycin module. ## Predictive Performance of Published and Refit Vancomycin PK Models in Pediatric CVICU Patients ![CVICU-pediatric-model-comparison](https://blog.insight-rx.com/hs-fs/hubfs/CVICU-pediatric-model-comparison.png?width=936&height=936&name=CVICU-pediatric-model-comparison.png) **Above**: Predictive performance of published and refit pharmacokinetic models for pediatric cardiovascular intensive care unit (CVICU) patients receiving vancomycin. Assessed by root mean square error (RMSE), mean percentage error (MPE), and prediction accuracy. Error bars represent the point and 95% confidence interval estimate for each model. For RMSE and accuracy, the dotted lines represent the upper and lower limits of the clinically acceptable range, respectively. For MPE, the dotted lines represent the lower and upper limits of the clinically acceptable range, and the solid line represents a target value of zero bias. ## Why This Matters: Equity in Precision Dosing This work is part of our broader effort to [improve healthcare equity in special patient populations](https://blog.insight-rx.com/resources/how-clinical-decision-support-precision-dosingcan-enhance-healthcare-equity-inclusion) receiving vancomycin (and other drugs), including: - [Neonatal and pediatric populations](https://blog.insight-rx.com/resources/evaluation-neonatal-paediatric-vancomycin-pharmacokinetic-models-impact-maturation-serum-creatinine-covariates-large-multicentre-data-set) - [Critically ill adult patients on continuous renal replacement therapy (CRRT)](https://blog.insight-rx.com/resources/new-model-for-vancomycin-patients-on-hemodialysis-improves-predictive-performance) - Pediatric oncology patients (coming in Part II of this series) By refining and validating models for subpopulations like pediatric CVICU patients, we aim to bring safer, more effective dosing to patients who need it most. Take a look at [Part II](https://blog.insight-rx.com/resources/vancomycin-dosing-pediatrics-oncology-model-selection), where we explore vancomycin model performance in pediatric oncology patients, another population with unique PK challenges. Want to Dive Deeper? Learn more about our model selection, evaluation, and improvement process by reading the full analysis below. [![Read the Analysis](https://no-cache.hubspot.com/cta/default/40041574/interactive-193676967569.png)](https://blog.insight-rx.com/hs/cta/wi/redirect?encryptedPayload=AVxigLI5cZkH30ZcvCH0anTkEN2WExjDnfyGtYN4v8NFgp1e086s2eNphM2UYolI1%2BX6TeT36m5To3s0WEQMdYZkRjQqlm%2B0pdgRmVSuJovgPl2A7ZVvu7ApyT%2Bi4JbHQVGCZosYOB%2FQxJ1Z%2B0dbjEmrtZlwpl5XtjNC%2BdPLauHZangHivjYovYqOnoUAsH15Y2U8Wy4To5UKtrhRnUJrLAj2ytA3TZoNeaT8PXYSzPX8H2MLqgGC8G6CMHWSAxaPZAZf8fMfEni3g00Tp9JQY5QjfwubdC8Tq3Z%2BXbVK9%2Btncr1giJ4kA%3D%3D&webInteractiveContentId=193676967569&portalId=40041574) --- These findings were later published in: McCarthy, M.G., Keizer, R.J. & Hughes, J.H. Evaluation and Improvement of Specialized Vancomycin Pharmacokinetic Models for Pediatric Cardiovascular Intensive Care Unit and Pediatric Oncology Patients. Clin Pharmacokinet (2026). [https://doi.org/10.1007/s40262-026-01623-7](https://doi.org/10.1007/s40262-026-01623-7) [vancomycin](https://blog.insight-rx.com/resources/tag/vancomycin) [model selection](https://blog.insight-rx.com/resources/tag/model-selection) [pediatrics](https://blog.insight-rx.com/resources/tag/pediatrics) [critical care](https://blog.insight-rx.com/resources/tag/critical-care) #### On this page… About the author [Michael McCarthy, MSc](https://blog.insight-rx.com/resources/author/michael-mccarthy) Data Scientist **Connect with us to get the latest blog updates, instantly sent to your inbox** ## Dig deeper. Explore related articles and additional posts on the InsightRX blog. [Product Innovation Aug 8, 2025 Improving Vancomycin Dosing in Pediatric Subpopulations (Part II): Guiding Model Selection in Oncology Patients](https://blog.insight-rx.com/resources/vancomycin-dosing-pediatrics-oncology-model-selection) [Product Innovation Jul 16, 2025 Elevating Precision Dosing for Hemodialysis Patients: A New Vancomycin CRRT Model](https://blog.insight-rx.com/resources/new-model-for-vancomycin-patients-on-hemodialysis-improves-predictive-performance) [Product Innovation Sep 5, 2025 New Continuous Learning PK Model Outperforms Published PopPK Models for Gentamicin](https://blog.insight-rx.com/resources/continuous-learning-approach-gentamicin-precision-dosing) #### What We Do ##### For Providers - [Nova (Bayesian Dosing)](https://www.insight-rx.com/provider/nova) - [Apollo (Clinical Analytics)](https://www.insight-rx.com/provider/apollo) - [Drug Modules](https://www.insight-rx.com/provider/drug-modules) ##### For Life Sciences - [Nova (MIPD for Clinical Trials)](https://www.insight-rx.com/life-sciences/nova) - [Astra (AI-Powered Clin Pharm)](https://www.insight-rx.com/life-sciences/astra) - [Companion Applications](https://www.insight-rx.com/life-sciences/nova#companion-applications) #### How We Do It ##### Platform - [Continuous Learning](https://www.insight-rx.com/platform/continuous-learning) - [Integrations](https://www.insight-rx.com/platform/integrations) - [Security & Regulatory](https://www.insight-rx.com/platform/security-regulatory) - [Success & Support](https://www.insight-rx.com/platform/success-support) ##### Science - [Data Science](https://www.insight-rx.com/data-science) - [Scientific Publications](https://www.insight-rx.com/data-science/scientific-publications) #### Information ##### Resources - [Success Stories](https://www.insight-rx.com/success-stories) - [White Papers](https://www.insight-rx.com/white-papers) - [Publications Using InsightRX](https://www.insight-rx.com/publications-using-insightrx-software) - [How to Cite InsightRX](https://www.insight-rx.com/how-to-cite-insightrx-nova) ##### Blog - [All Posts](https://blog.insight-rx.com/resources) - [Product Innovation](https://blog.insight-rx.com/resources?section=product_innovation) - [Thought Leadership](https://blog.insight-rx.com/resources?section=thought_leadership) #### About - [Our Story](https://www.insight-rx.com/about) - [Leadership](https://www.insight-rx.com/leadership) - [Advisory Board](https://www.insight-rx.com/advisory-board) - [Our Customers](https://www.insight-rx.com/customers) - [Press Releases](https://blog.insight-rx.com/press-releases?section=press_releases) - [Media](https://blog.insight-rx.com/press-releases?section=media) - [Careers](https://www.insight-rx.com/careers) - [Contact](https://www.insight-rx.com/contact-us) --- ![CE marking](https://blog.insight-rx.com/hubfs/ce-mark-white.svg) InsightRX Nova is HITRUST CSF r2 certified, CE marked, and 21 CFR Part 11 compliant. Our quality management, risk management, software lifecycle, and usability engineering processes conform to ISO 13485, IEC 62304, ISO 14971, IEC 62366-1, and IEC 82304-1. InsightRX Nova is not considered to be a medical device in the U.S. and has not been submitted to the U.S. Food and Drug Administration for review or clearance. 740-05000-REC-01 · 08/2025 --- [![InsightRX](https://blog.insight-rx.com/hubfs/insightrx_logo_white-teal.svg)](https://www.insight-rx.com/) 548 Market Street #88083 San Francisco, CA 94104 --- © 2026 InsightRX, Inc. All rights reserved. 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