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Ecmo, drug dosing

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https://www.readbyqxmd.com/read/27815558/in-vitro-effects-of-an-extracorporeal-membrane-oxygenation-circuit-on-the-sequestration-of-%C3%AF%C2%B5-aminocaproic-acid
#1
Deborah Wagner, Miguel Caraballo, John Waldvogel, Yuki Peterson, Duxin Sun
OBJECTIVE: To assess the in vitro effects of drug sequestration in extracorporeal membrane oxygenation (ECMO) on ϵ-aminocaproic acid (EACA) concentrations. METHODS AND DESIGN: This in vitro study will determine changes in EACA concentration over time in ECMO circuits. A pediatric dose of 2,500 mg was administered to whole expired blood in the simulated pediatric ECMO circuit. Blood samples were collected at 0, 30, 60, 360 and 1440-minute intervals after initial administration equilibration from three different sites of the circuit: pre-oxygenator (PRE), post-oxygenator (POST) and PVC tubing (PVC) to determine the predominant site of drug loss...
November 3, 2016: Perfusion
https://www.readbyqxmd.com/read/27667276/-the-effect-and-factors-associated-with-outcome-of-extracorporeal-membrane-oxygenation-in-refractory-cardiogenic-shock-patients
#2
R Q Zhu, C Z Liu, J H Lu, Y P Su, S C Wen, G J Nie, Y Z Hu, L E Zuo
Objective: To observe the clinical efficacy and factors associated with outcome of extracorporeal membrane oxygenation (ECMO) in refractory cardiogenic shock patients. Methods: Patients with refractory cardiogenic shock received ECMO treatment in our hospital from May 2013 to November 2015 were retrospectively analyzed. The clinical status before ECMO support, ECMO timing, complications and outcome were observed and analyzed.The hemodynamic data and the amount of vasoactive drugs at 2 hours before ECMO support and at 2, 6, 24 and 48 hours after ECMO support were collected and compared...
September 24, 2016: Zhonghua Xin Xue Guan Bing za Zhi
https://www.readbyqxmd.com/read/27553752/pharmacokinetics-and-dosing-of-anti-infective-drugs-in-patients-on-extracorporeal-membrane-oxygenation-a-review-of-the-current-literature
#3
REVIEW
Jennifer Sherwin, Travis Heath, Kevin Watt
PURPOSE: Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass device that is used to temporarily support the most critically ill of patients with respiratory and/or cardiac failure. Infection and its sequelae may be an indication for ECMO or infections may be acquired while on ECMO and are associated with a mortality >50%. Effective therapy requires optimal dosing. However, optimal dosing can be different in patients on ECMO because the ECMO circuit can alter drug pharmacokinetics...
September 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27322360/pharmacotherapy-during-pediatric-extracorporeal-membrane-oxygenation-a-review
#4
Adam S Himebauch, Todd J Kilbaugh, Athena F Zuppa
INTRODUCTION: Pediatric critical illness and associated alterations in organ function can change drug pharmacokinetics (PK). Extracorporeal membrane oxygenation (ECMO), a life-saving therapy for severe cardiac and/or respiratory failure, causes additional PK alterations that affect drug disposition. AREAS COVERED: The purposes of this review are to discuss the PK changes that occur during ECMO, the associated therapeutic implications, and to review PK literature relevant to pediatric ECMO...
October 2016: Expert Opinion on Drug Metabolism & Toxicology
https://www.readbyqxmd.com/read/27314826/pharmacokinetics-and-safety-of-micafungin-in-infants-supported-with-extracorporeal-membrane-oxygenation
#5
Julie Autmizguine, Christoph P Hornik, Daniel K Benjamin, Kim L R Brouwer, Susan R Hupp, Michael Cohen-Wolkowiez, Kevin M Watt
BACKGROUND: Candida is a leading cause of infection in infants on extracorporeal membrane oxygenation (ECMO). Optimal micafungin dosing is unknown in this population because ECMO can alter drug pharmacokinetics (PK). METHODS: To characterize micafungin pharmacokinetics and safety in infants on ECMO, we conducted an open-label pharmacokinetics trial. Infants on ECMO either received intravenous micafungin 4 mg/kg every 24 h for invasive candidiasis prophylaxis or 8 mg/kg every 24 h when a fungal infection was suspected or confirmed...
November 2016: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/26913719/survival-after-cardiac-arrest-ecmo-rescue-therapy-after-amlodipine-and-metoprolol-overdose
#6
Kevin F Maskell, Nikki Miller Ferguson, Jesse Bain, Brandon K Wills
Extracorporeal membrane oxygenation (ECMO) use in poisoned patients is increasing, but is rare post cardiac arrest. We report a case of ECMO use with complete recovery in a patient who arrested twice after a cardiotoxicant overdose. A 17-year-old male presented after an unknown overdose. He rapidly became hypotensive and bradycardic and received aggressive supportive care without improvement. He was transferred to our institution and suffered a cardiac arrest shortly after arrival. Six minutes of advanced cardiac life support resulted in return of spontaneous circulation...
February 25, 2016: Cardiovascular Toxicology
https://www.readbyqxmd.com/read/26667471/can-physicochemical-properties-of-antimicrobials-be-used-to-predict-their-pharmacokinetics-during-extracorporeal-membrane-oxygenation-illustrative-data-from-ovine-models
#7
Kiran Shekar, Jason A Roberts, Adrian G Barnett, Sara Diab, Steven C Wallis, Yoke L Fung, John F Fraser
INTRODUCTION: Ex vivo experiments in extracorporeal membrane oxygenation (ECMO) circuits have identified octanol-water partition coefficient (logP, a marker of lipophilicity) and protein binding (PB) as key drug factors affecting pharmacokinetics (PK) during ECMO. Using ovine models, in this study we investigated whether these drug properties can be used to predict PK alterations of antimicrobial drugs during ECMO. METHODS: Single-dose PK sampling was performed in healthy sheep (HS, n = 7), healthy sheep on ECMO (E24H, n = 7) and sheep with smoke inhalation acute lung injury on ECMO (SE24H, n = 6)...
December 15, 2015: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/26518065/single-and-multiple-dose-pharmacokinetics-of-ethambutol-and-rifampicin-in-a-tuberculosis-patient-with-acute-respiratory-distress-syndrome-undergoing-extended-daily-dialysis-and-ecmo-treatment
#8
Ann-Kathrin Strunk, Sandra Ciesek, Julius J Schmidt, Christian Kühn, Marius M Hoeper, Tobias Welte, Jan T Kielstein
The dosing of drugs in critically ill patients undergoing renal replacement therapy is based on limited data. We report for the first time single- and multiple-dose pharmacokinetics of ethambutol (EMB), which is cleared renally to 80%, and rifampicin (RIF), which is cleared renally to <30%, in a patient requiring both extracorporeal membrane oxygenation (ECMO) and renal replacement therapy. Extended dialysis removed a considerable amount of both EMB and RIF, with a dialyser plasma clearance ranging between 37 and 95 ml/min for EMB and between 39 and 53 ml/min for RIF...
January 2016: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/26512570/a-case-report-of-churg-strauss-syndrome-presenting-with-cardiogenic-shock-treated-with-extracorporeal-membrane-oxygenation
#9
Na Cui, Longxiang Su, Hao Wang, Yun Long, Cheng Pang, Fei Yang, Dawei Liu
Churg-Strauss Syndrome (CSS) complicated with cardiogenic shock is rare. Few case reports have described successful treatment of this rare disease. However, no one has reported on the application of mechanical life support with extracorporeal membrane oxygenation (ECMO) to treat this life-threatening disease.A 36-year-old female with limb numbness for >10 days, chest tightness for 2 days, and worsening dyspnea for 5 h presented in the emergency room. Vital signs showed a low blood pressure (104/60 mm Hg), increased heart rate (158 bpm), and respiration rate (28 bpm)...
October 2015: Medicine (Baltimore)
https://www.readbyqxmd.com/read/26323408/the-impact-of-hypothermia-on-the-pharmacokinetics-of-drugs-used-in-neonates-and-young-infants
#10
REVIEW
P Pokorna, E D Wildschut, V Vobruba, John N van den Anker, D Tibboel
Therapeutic hypothermia (HT) is frequently used in neonates with hypoxic-ischemic encephalopathy and young infants during cardiopulmonary bypass (CPB). Hypothermia and CPB result in physiological changes contributing to pharmacokinetic (PK) and pharmacodynamic (PD) changes. Changes in the absorption, the volume of distribution (Vd) and the total body clearance (CL) of drugs used during hypothermia and CPB might lead to the interindividual PK variability resulting in either insufficient or toxic plasma concentrations and have an impact on the biodisposition and action of drugs...
2015: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/26266926/macro-and-micronutrient-disposition-in-an-ex-vivo-model-of-extracorporeal-membrane-oxygenation
#11
Kristine Estensen, Kiran Shekar, Elissa Robins, Charles McDonald, Adrian G Barnett, John F Fraser
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) circuits have been shown to sequester circulating blood compounds such as drugs based on their physicochemical properties. This study aimed to describe the disposition of macro- and micronutrients in simulated ECMO circuits. METHODS: Following baseline sampling, known quantities of macro- and micronutrients were injected post oxygenator into ex vivo ECMO circuits primed with the fresh human whole blood and maintained under standard physiologic conditions...
December 2014: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/26242293/levetiracetam-pharmacokinetics-in-a-patient-receiving-continuous-venovenous-hemofiltration-and-venoarterial-extracorporeal-membrane-oxygenation
#12
Scott D Nei, Erica D Wittwer, Kianoush B Kashani, Erin N Frazee
Levetiracetam is a first-line therapy for seizures in critically ill patients because of its clinical efficacy, minimal drug interactions, and wide therapeutic window. The primary mechanism of levetiracetam clearance is renal, and the drug has a low molecular weight. It is hydrophilic and exhibits minimal protein binding. Thus it is expected that levetiracetam will be removed by continuous venovenous hemofiltration (CVVH), with limited clearance by venoarterial extracorporeal membrane oxygenation (ECMO). We describe the case of a 67-year-old man who was admitted to the cardiovascular surgery intensive care unit after cardiac arrest and initiation of venoarterial ECMO...
August 2015: Pharmacotherapy
https://www.readbyqxmd.com/read/25896706/fluconazole-population-pharmacokinetics-and-dosing-for-prevention-and-treatment-of-invasive-candidiasis-in-children-supported-with-extracorporeal-membrane-oxygenation
#13
Kevin M Watt, Daniel Gonzalez, Daniel K Benjamin, Kim L R Brouwer, Kelly C Wade, Edmund Capparelli, Jeffrey Barrett, Michael Cohen-Wolkowiez
Candida infections are a leading cause of infectious disease-related death in children supported by extracorporeal membrane oxygenation (ECMO). The ECMO circuit can alter drug pharmacokinetics (PK); thus, standard fluconazole dosing may result in suboptimal drug exposures. The objective of our study was to determine the PK of fluconazole in children on ECMO. Forty children with 367 PK samples were included in the analysis. The PK data were analyzed using nonlinear mixed-effect modeling (NONMEM). A one-compartment model best described the data...
July 2015: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/25888449/protein-bound-drugs-are-prone-to-sequestration-in-the-extracorporeal-membrane-oxygenation-circuit-results-from-an-ex-vivo-study
#14
Kiran Shekar, Jason A Roberts, Charles I Mcdonald, Sussan Ghassabian, Chris Anstey, Steven C Wallis, Daniel V Mullany, Yoke L Fung, John F Fraser
INTRODUCTION: Vital drugs may be degraded or sequestered in extracorporeal membrane oxygenation (ECMO) circuits, with lipophilic drugs considered to be particularly vulnerable. However, the circuit effects on protein-bound drugs have not been fully elucidated. The aim of this experimental study was to investigate the influence of plasma protein binding on drug disposition in ex vivo ECMO circuits. METHODS: Four identical ECMO circuits comprising centrifugal pumps and polymethylpentene oxygenators and were used...
April 14, 2015: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/25886890/propofol-midazolam-vancomycin-and-cyclosporine-therapeutic-drug-monitoring-in-extracorporeal-membrane-oxygenation-circuits-primed-with-whole-human-blood
#15
Florian Lemaitre, Nesrine Hasni, Pascal Leprince, Emmanuel Corvol, Ghassen Belhabib, Pierre Fillâtre, Charles-Edouard Luyt, Cyril Leven, Robert Farinotti, Christine Fernandez, Alain Combes
INTRODUCTION: As a result of drug sequestration and increased volume of distribution, the extracorporeal membrane oxygenation (ECMO) procedure might lead to a decrease in drug concentrations during a patient's treatment. The aim of this study was to evaluate sedative, antibiotic and immunosuppressive drug loss in ECMO circuit using ex-vivo and in-vitro experiments. METHODS: Blood concentrations of propofol, midazolam, cyclosporine and vancomycin were measured in an ex-vivo ECMO circuit primed with whole human blood, and compared to controls stored in polypropylene tubes...
2015: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/25745797/successful-treatment-of-metoprolol-induced-cardiac-arrest-with-high-dose-insulin-lipid-emulsion-and-ecmo
#16
Jeremiah T Escajeda, Ken D Katz, Jon C Rittenberger
β-Adrenergic antagonist toxicity causes cardiovascular collapse often refractory to standard therapy. Alternative therapies include high-dose insulin, lipid emulsion, and venoarterial extracorporeal membrane oxygenation (VA-ECMO). A 47-year-old man ingested 10 g of metoprolol tartrate in a suicide attempt. Upon emergency department presentation, he was comatose, bradycardic, and hypotensive. Glucagon (14 mg IV) and vasopressor/inotropic support (epinephrine 0.1 μg/[kg min], dobutamine 10 μg/[kg min]) were administered...
August 2015: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/25636084/the-combined-effects-of-extracorporeal-membrane-oxygenation-and-renal-replacement-therapy-on-meropenem-pharmacokinetics-a-matched-cohort-study
#17
COMPARATIVE STUDY
Kiran Shekar, John F Fraser, Fabio Silvio Taccone, Susan Welch, Steven C Wallis, Daniel V Mullany, Jeffrey Lipman, Jason A Roberts
INTRODUCTION: The scope of extracorporeal membrane oxygenation (ECMO) is expanding; however, optimal drug prescription during ECMO remains a developing science. Currently, there are no clear guidelines for antibiotic dosing during ECMO. This open-label, descriptive, matched-cohort pharmacokinetics (PK) study aimed to compare the PK of meropenem in ECMO patients to critically ill patients with sepsis not receiving ECMO (controls). METHODS: Eleven adult patients on ECMO (venovenous (VV) ECMO, n = 6; venoarterial (VA) ECMO, n = 5) receiving intravenous (IV) meropenem were included...
December 12, 2014: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/25572932/alveolar-and-serum-concentrations-of-imipenem-in-two-lung-transplant-recipients-supported-with-extracorporeal-membrane-oxygenation
#18
C Welsch, P Augustin, J Allyn, L Massias, P Montravers, N Allou
Venovenous extracorporeal membrane oxygenation (ECMO) is increasingly used in patients with respiratory failure who fail conventional treatment. Postoperative pneumonia is the most common infection after lung transplantation (40%). Imipenem is frequently used for empirical treatment of nosocomial pneumonia in the intensive care unit. Nevertheless, few data are available on the impact of ECMO on pharmacokinetics, and no data on imipenem dosing during ECMO. Currently, no guidelines exist for antibiotic dosing during ECMO support...
February 2015: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/25542059/%C3%AE-lactam-pharmacokinetics-during-extracorporeal-membrane-oxygenation-therapy-a-case-control-study
#19
Katia Donadello, Elio Antonucci, Stefano Cristallini, Jason A Roberts, Marjorie Beumier, Sabino Scolletta, Frédérique Jacobs, Benoit Rondelet, Daniel de Backer, Jean-Louis Vincent, Fabio Silvio Taccone
Most adult patients receiving extracorporeal membrane oxygenation (ECMO) require antibiotic therapy, however the pharmacokinetics of β-lactams have not been well studied in these conditions. In this study, data from all patients receiving ECMO support and meropenem (MEM) or piperacillin/tazobactam (TZP) were reviewed. Drug concentrations were measured 2h after the start of a 30-min infusion and just before the subsequent dose. Therapeutic drug monitoring (TDM) results in ECMO patients were matched with those in non-ECMO patients for (i) drug regimen, (ii) renal function, (iii) total body weight, (iv) severity of organ dysfunction and (v) age...
March 2015: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/25416535/vancomycin-population-pharmacokinetics-during-extracorporeal-membrane-oxygenation-therapy-a-matched-cohort-study
#20
Katia Donadello, Jason A Roberts, Stefano Cristallini, Marjorie Beumier, Kiran Shekar, Frédérique Jacobs, Asmae Belhaj, Jean-Louis Vincent, Daniel de Backer, Fabio Silvio Taccone
INTRODUCTION: The aim of this study was to describe the population pharmacokinetics of vancomycin in critically ill patients treated with and without extracorporeal membrane oxygenation (ECMO). METHODS: We retrospectively reviewed data from critically ill patients treated with ECMO and matched controls who received a continuous infusion of vancomycin (35 mg/kg loading dose over 4 hours followed by a daily infusion adapted to creatinine clearance, CrCl)). The pharmacokinetics of vancomycin were described using non-linear mixed effects modeling...
2014: Critical Care: the Official Journal of the Critical Care Forum
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