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The Effect of Ecmo on the New Vancomycin Dosing Regimen in Critically Ill Patients Receiving Continuous Veno-Venous Hemofiltration.
Therapeutic Drug Monitoring 2018 Februrary 15
BACKGROUND: The optimal dosing regimen of vancomycin for critically ill patients receiving continuous veno-venous hemofiltration (CVVH) remains controversial, not to mention those with concurrent use of extracorporeal membrane oxygenation (ECMO). We aimed to determine if a new dosing regimen can achieve the target vancomycin trough concentration (Ctrough) of 10-20 μg/mL in patients receiving CVVH with or without ECMO.
METHODS: We conducted a retrospective study by enrolling patients who received vancomycin while undergoing CVVH. The vancomycin dosing regimen was 15-20 mg/kg as the loading dose and 7.5 mg/kg every 12 h as the maintenance doses. Serum concentration was determined after at least four doses of vancomycin were given.
RESULTS: A total of 38 patients were enrolled, of which 21 were also on ECMO. The ultrafiltration rate of CVVH was 30.6 ± 5.5 mL/kg/h with the Ctrough of 14.7 ± 3.5 μg/mL. Ctrough was within the target range in 82% of patients. All CVVH-only patients achieved the target concentration, while only 76.2% of those with concurrent ECMO did (p = 0.031).
CONCLUSIONS: All patients receiving CVVH achieved the target Ctrough with this new dosing regimen, but those with concurrent ECMO did not. Ctrough must be more closely monitored in patients using ECMO simultaneously.
METHODS: We conducted a retrospective study by enrolling patients who received vancomycin while undergoing CVVH. The vancomycin dosing regimen was 15-20 mg/kg as the loading dose and 7.5 mg/kg every 12 h as the maintenance doses. Serum concentration was determined after at least four doses of vancomycin were given.
RESULTS: A total of 38 patients were enrolled, of which 21 were also on ECMO. The ultrafiltration rate of CVVH was 30.6 ± 5.5 mL/kg/h with the Ctrough of 14.7 ± 3.5 μg/mL. Ctrough was within the target range in 82% of patients. All CVVH-only patients achieved the target concentration, while only 76.2% of those with concurrent ECMO did (p = 0.031).
CONCLUSIONS: All patients receiving CVVH achieved the target Ctrough with this new dosing regimen, but those with concurrent ECMO did not. Ctrough must be more closely monitored in patients using ECMO simultaneously.
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