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ecmo pharmacokinetics

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https://www.readbyqxmd.com/read/29112080/%C3%AE-lactam-therapeutic-drug-management-in-the-picu
#1
Jeffrey J Cies, Wayne S Moore, Adela Enache, Arun Chopra
OBJECTIVES: To determine whether contemporary β-lactam anti-infective dosing recommendations in critically ill children achieve concentrations associated with maximal anti-infective activity. The secondary objective was to describe the microbiological and clinical outcomes associated with β-lactam therapeutic drug management. DESIGN: Electronic Medical Record Review. SETTING: A 189-bed, freestanding children's tertiary care teaching hospital in Philadelphia, PA...
November 3, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29099462/pharmacokinetic-pharmacodynamic-target-attainment-during-extracorporeal-membrane-oxygenation-does-the-circuit-matter
#2
Jacopo Colombo, Ilenia Scaffidi
No abstract text is available yet for this article.
November 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29045281/pharmacokinetics-of-amikacin-in-critical-care-patients-on-extracorporeal-device
#3
Jesus Ruiz-Ramos, Ricardo Gimeno, Francisca Pérez, Paula Ramirez, Esther Villarreal, Monica Gordon, Carlos Vicent, María Remedios Marqués, Álvaro Castellanos-Ortega
In this study, we evaluate the effect of extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (Levitronix) on the pharmacokinetic of amikacin in critically ill patients. Twelve patients with ECMO and three with Levitronix devices who started treatment with amikacin were included. Amikacin pre (Cmax) and post (Cmin) dose serum concentrations were measured during the first 72-96 hours of treatment initiation. Pharmacokinetic parameters were performed by Bayesian adjustment. The median initial dose was 1,000 mg (range: 600-1,400 mg)...
October 18, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28948652/pharmacokinetic-changes-of-antibiotic-antiviral-antituberculosis-and-antifungal-agents-during-extracorporeal-membrane-oxygenation-in-critically-ill-adult-patients
#4
REVIEW
J Hahn, J H Choi, M J Chang
WHAT IS KNOWN AND OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a life-saving system used for critically ill patients with cardiac and/or respiratory failure. The pharmacokinetics (PK) of drugs can change in patients undergoing ECMO, which can result in therapeutic failure or drug toxicity requiring further management of drug complications. In this review, we discussed changes in the PK of antibiotic, antiviral, antituberculosis and antifungal agents administered to adult patients on ECMO...
September 25, 2017: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/28887935/medication-complications-in-extracorporeal-membrane-oxygenation
#5
REVIEW
Ami G Shah, Michelle Peahota, Brandi N Thoma, Walter K Kraft
The need for extracorporeal membrane oxygenation (ECMO) therapy is a marker of disease severity for which multiple medications are required. The therapy causes physiologic changes that impact drug pharmacokinetics. These changes can lead to exposure-driven decreases in efficacy or increased incidence of side effects. The pharmacokinetic changes are drug specific and largely undefined for most drugs. We review available drug dosing data and provide guidance for use in the ECMO patient population.
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28674057/population-pharmacokinetics-and-dose-optimization-of-teicoplanin-during-venoarterial-extracorporeal-membrane-oxygenation
#6
Jin Wi, Hayeon Noh, Kyoung Lok Min, Seungwon Yang, Byung Hak Jin, Jongsung Hahn, Soo Kyung Bae, Jiseon Kim, Min Soo Park, Donghoon Choi, Min Jung Chang
The pharmacokinetics (PK) of drugs are known to be significantly altered in patients receiving extracorporeal membrane oxygenation (ECMO). However, clinical studies of the PK of drugs administered during ECMO are scarce, and the proper dosing adjustment has yet to be established. We developed a population PK model for teicoplanin, investigated covariates influencing teicoplanin exposure, and suggested an optimal dosing regimen for ECMO patients. Samples for PK analysis were collected from 10 adult patients, and a population PK analysis and simulations were performed to identify an optimal teicoplanin dose needed to provide a >50% probability of target attainment at 72 h using a trough concentration target of >10 μg/ml for mild to moderate infections and a trough concentration target of >15 μg/ml for severe infections...
September 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28638161/argatroban-for-heparin-induced-thrombocytopenia-during-venovenous-extracorporeal-membrane-oxygenation-with-continuous-venovenous-hemofiltration
#7
Jonathan H Sin, Natasha D Lopez
Patients receiving extracorporeal membrane oxygenation (ECMO) are at risk of circuit thrombosis due to constant contact between blood and the extracorporeal components. Unfractionated heparin has traditionally been used in this setting as a systemic form of anticoagulation to prevent thrombosis of the circuit. However, if a patient develops heparin-induced thrombocytopenia (HIT), an alternative anticoagulant would be required while the patient is maintained on ECMO. Unfortunately, the pharmacokinetic changes induced by ECMO and critical illness may potentially affect optimal drug dosing...
June 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28384599/the-effect-of-veno-venous-ecmo-on-the-pharmacokinetics-of-ritonavir-darunavir-tenofovir-and-lamivudine
#8
Mohamed A Ghazi Suliman, Kayode Ogungbenro, Christos Kosmidis, Alan Ashworth, Julian Barker, Anita Szabo-Barnes, Andrew Davies, Lee Feddy, Igor Fedor, Tim Hayes, Sarah Stirling, Ignacio Malagon
INTRODUCTION: To our knowledge, there is no published data on the pharmacokinetic (PK) profile of antiretroviral (ART) drugs on patients undergoing extracorporeal membrane oxygenation (ECMO) therapy. We present PK analyses of Ritonavir, Darunavir, Lamivudine and Tenofovir in a patient with HIV who required veno-venous ECMO (VV ECMO). METHODS: Plasma concentrations for Ritonavir, Darunavir, Tenofovir and Lamivudine were obtained while the patient was on ECMO following pre-emptive dose adjustments...
March 12, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28078682/population-pharmacokinetics-of-intravenous-clonidine-for-sedation-during-paediatric-extracorporeal-membrane-oxygenation-and-continuous-venovenous-hemofiltration
#9
Niina Kleiber, Ron A A Mathôt, Maurice J Ahsman, Enno D Wildschut, Dick Tibboel, Saskia N de Wildt
AIMS: Clonidine is used for sedation in the paediatric intensive care unit. Extracorporeal membrane oxygenation (ECMO) provides temporary support if respiratory and cardiac function is threatened. ECMO influences the pharmacokinetics of drugs. Clonidine during paediatric ECMO cannot be effectively titrated as PK data are lacking. The aim of this study is to describe clonidine PK in a particular ECMO system and propose dosing guidelines for children on this particular ECMO circuit. METHODS: All children below the age of 18 years who received clonidine during ECMO were eligible...
June 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28033162/ex-vivo-model-to-decipher-the-impact-of-extracorporeal-membrane-oxygenation-on-beta-lactam-degradation-kinetics
#10
Cyril Leven, Pierre Fillâtre, Antoine Petitcollin, Marie-Clémence Verdier, Jérôme Laurent, Nicolas Nesseler, Yoann Launey, Pierre Tattevin, Eric Bellissant, Erwan Flécher, Florian Lemaitre
BACKGROUND: As a consequence of drug sequestration, increase in volume of distribution, or alteration of elimination, extracorporeal membrane oxygenation (ECMO) might lead to inadequate plasma concentrations of vital drugs. The aim of this experimental study was to develop an ex vivo model to better characterize the impact of ECMO procedure on beta-lactam antibiotics pharmacokinetics. METHODS: Plasma concentrations of cefotaxime, ceftazidime, cefepime, piperacillin, oxacillin, amoxicillin, and ceftriaxone were measured in an ex vivo ECMO circuit primed with whole human blood and compared with controls stored in glass tubes and polyvinyl chloride tubing...
April 2017: Therapeutic Drug Monitoring
https://www.readbyqxmd.com/read/27931091/evaluation-of-altered-drug-pharmacokinetics-in-critically-ill-adults-receiving-extracorporeal-membrane-oxygenation
#11
REVIEW
Michael A Ha, Adam C Sieg
Extracorporeal membrane oxygenation (ECMO) is a life-support modality used in patients with refractory cardiac and/or respiratory failure. A significant resurgence in the use ECMO has been seen in recent years as a result of substantial improvements in technology and survival benefit. With expanding ECMO use, a better understanding of how ECMO affects drug pharmacokinetics (PK) is necessary. The vast majority of PK studies in patients receiving ECMO have been conducted within neonatal or pediatric populations or within a controlled environment (e...
February 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/27639260/a-population-pharmacokinetic-model-for-vancomycin-in-adult-patients-receiving-extracorporeal-membrane-oxygenation-therapy
#12
J N Moore, J R Healy, B N Thoma, M M Peahota, M Ahamadi, L Schmidt, N C Cavarocchi, W K Kraft
The literature on the pharmacokinetics of vancomycin in patients undergoing extracorporeal membrane oxygenation (ECMO) therapy is sparse. A population pharmacokinetic (PK) model for vancomycin in ECMO patients was developed using a nonlinear mixed effects modeling on the concentration-time profiles of 14 ECMO patients who received intravenous vancomycin. Model selection was based on log-likelihood criterion, goodness of fit plots, and scientific plausibility. Identification of covariates was done using a full covariate model approach...
September 2016: CPT: Pharmacometrics & Systems Pharmacology
https://www.readbyqxmd.com/read/27585904/clinical-pharmacology-studies-in-critically-ill-children
#13
REVIEW
Nilay Thakkar, Sara Salerno, Christoph P Hornik, Daniel Gonzalez
Developmental and physiological changes in children contribute to variation in drug disposition with age. Additionally, critically ill children suffer from various life-threatening conditions that can lead to pathophysiological alterations that further affect pharmacokinetics (PK). Some factors that can alter PK in this patient population include variability in tissue distribution caused by protein binding changes and fluid shifts, altered drug elimination due to organ dysfunction, and use of medical interventions that can affect drug disposition (e...
January 2017: Pharmaceutical Research
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
#14
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/27502103/bosentan-as-adjunctive-therapy-for-persistent-pulmonary-hypertension-of-the-newborn-results-of-the-randomized-multicenter-placebo-controlled-exploratory-trial
#15
RANDOMIZED CONTROLLED TRIAL
Robin H Steinhorn, Jeffrey Fineman, Andjela Kusic-Pajic, Peter Cornelisse, Martine Gehin, Pegah Nowbakht, Christine M Pierce, Maurice Beghetti
OBJECTIVE: To evaluate the efficacy, safety, and pharmacokinetics of the endothelin receptor antagonist bosentan as adjunctive therapy for neonates with persistent pulmonary hypertension of the newborn (PPHN). STUDY DESIGN: This was a phase 3, multicenter, randomized, placebo-controlled exploratory trial (FUTURE-4). Eligible patients were >34 weeks gestation, <7 days old, receiving inhaled nitric oxide (iNO) treatment (≥4 hours), and had persistent respiratory failure (oxygenation index [OI] ≥12)...
October 2016: Journal of Pediatrics
https://www.readbyqxmd.com/read/27411507/heparin-induced-thrombocytopenia-in-cardiac-surgery-and-critically-ill-patients
#16
Sixten Selleng, Kathleen Selleng
Thrombocytopenia as well as anti-platelet factor 4/heparin (PF4/H) antibodies are common in cardiac surgery patients and those treated in the intensive care unit. In contrast, heparin-induced thrombocytopenia (HIT) is uncommon in these populations (~1 % and ~0.5 %, respectively). A stepwise approach where testing for anti-PF4/H antibodies is performed only in patients with typical clinical symptoms of HIT improves diagnostic specificity of the laboratory assays without losing sensitivity, thereby helping to avoid overdiagnosis and resulting HIT overtreatment...
October 28, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27322360/pharmacotherapy-during-pediatric-extracorporeal-membrane-oxygenation-a-review
#17
REVIEW
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
#18
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/26994602/pharmacokinetics-of-oral-and-intravenous-oseltamivir-treatment-of-severe-influenza-b-virus-infection-requiring-organ-replacement-therapy
#19
Katharina Karsch, Xi Chen, Oliver Miera, Björn Peters, Patrick Obermeier, Roland C Francis, Válerie Amann, Susanne Duwe, Pieter Fraaij, Alla Heider, Marcel de Zwart, Felix Berger, Albert Osterhaus, Brunhilde Schweiger, Barbara Rath
BACKGROUND AND OBJECTIVES: Patients with severe influenza virus infection, multi-organ failure and organ replacement therapy may absorb and metabolize neuraminidase inhibitors differently. Systematic pharmacokinetic/pharmacodynamic clinical trials are currently lacking in this high-risk group. Inadequate dosing increases the risk of treatment failure and drug resistance, especially in severely ill patients with elevated virus loads. This study aims to explore the impact of organ replacement therapy on oseltamivir drug concentrations...
February 2017: European Journal of Drug Metabolism and Pharmacokinetics
https://www.readbyqxmd.com/read/26645552/the-clinical-management-of-patients-on-partial-total-extracorporeal-support
#20
REVIEW
Darryl Abrams, Daniel Brodie
PURPOSE OF REVIEW: Despite advances in extracorporeal membrane oxygenation (ECMO) technology, much is unknown about the optimal management strategies for patients receiving extracorporeal support. There is a growing body of literature investigating patient selection and outcomes, mechanical ventilation approaches, anticoagulation, pharmacokinetics, early mobilization, and the role of ECMO transport among others. RECENT FINDINGS: Nonrandomized data suggest a survival advantage from ECMO compared with conventional management in acute respiratory distress syndrome, with mechanical ventilation practices varying widely across centers...
February 2016: Current Opinion in Critical Care
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