Pharmacokinetic changes of antibiotic, antiviral, antituberculosis and antifungal agents during extracorporeal membrane oxygenation in critically ill adult patients

Hahn, Jae Won; Choi, Ji Ha; Chang, Min Jung

doi:10.1111/jcpt.12636

Cited by 48 publications

(61 citation statements)

References 62 publications

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“…Studies indicate that oseltamivir administered orally or via oro/naso-gastric tube is well absorbed in critically ill patients and reaches plasma levels comparable to those in ambulatory patients [80]. Similarly, several observational studies indicate that enteric oseltamivir reaches comparable plasma concentrations to non-critically ill patients in those receiving extracorporeal membrane oxygenation (ECMO) and renal replacement therapy [80][81][82][83][84][85][86][87], although dosing should be reduced in patients with significant renal impairment. There is scant evidence that increased NAI dosing (e.g., twice daily dosing) in critically ill patients provides additional clinical benefit than standard dosing [80,[88][89][90][91][92].…”

Section: Treatment Of Influenzamentioning

confidence: 99%

Influenza virus-related critical illness: prevention, diagnosis, treatment

2019

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Annual seasonal influenza epidemics of variable severity result in significant morbidity and mortality in the United States (U.S.) and worldwide. In temperate climate countries, including the U.S., influenza activity peaks during the winter months. Annual influenza vaccination is recommended for all persons in the U.S. aged 6 months and older, and among those at increased risk for influenza-related complications in other parts of the world (e.g. young children, elderly). Observational studies have reported effectiveness of influenza vaccination to reduce the risks of severe disease requiring hospitalization, intensive care unit admission, and death. A diagnosis of influenza should be considered in critically ill patients admitted with complications such as exacerbation of underlying chronic comorbidities, community-acquired pneumonia, and respiratory failure during influenza season. Molecular tests are recommended for influenza testing of respiratory specimens in hospitalized patients. Antigen detection assays are not recommended in critically ill patients because of lower sensitivity; negative results of these tests should not be used to make clinical decisions, and respiratory specimens should be tested for influenza by molecular assays. Because critically ill patients with lower respiratory tract disease may have cleared influenza virus in the upper respiratory tract, but have prolonged influenza viral replication in the lower respiratory tract, an endotracheal aspirate (preferentially) or bronchoalveolar lavage fluid specimen (if collected for other diagnostic purposes) should be tested by molecular assay for detection of influenza viruses. Observational studies have reported that antiviral treatment of critically ill adult influenza patients with a neuraminidase inhibitor is associated with survival benefit. Since earlier initiation of antiviral treatment is associated with the greatest clinical benefit, standard-dose oseltamivir (75 mg twice daily in adults) for enteric administration is recommended as soon as possible as it is well absorbed in critically ill patients. Based upon observational data that suggest harms, adjunctive corticosteroid treatment is currently not recommended for children or adults hospitalized with influenza, including critically ill patients, unless clinically indicated for another reason, such as treatment of asthma or COPD exacerbation, or septic shock. A number of pharmaceutical agents are in development for treatment of severe influenza.

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Section: Treatment Of Influenzamentioning

confidence: 99%

Influenza virus-related critical illness: prevention, diagnosis, treatment

2019

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“…Venoarterial ECMO (VA-ECMO) provides support for both the heart and the lungs, while venovenous ECMO (VV-ECMO) only provides respiratory support. An increasing number of studies have shown that ECMO is associated with significant pharmacokinetic (PK) alterations, including an increased volume of distribution and reduced clearance ( 10 – 13 ). Studies on whether the PK of caspofungin will change in patients receiving ECMO are very limited and controversial.…”

Section: Introductionmentioning

confidence: 99%

Population Pharmacokinetics of Caspofungin among Extracorporeal Membrane Oxygenation Patients during the Postoperative Period of Lung Transplantation

Wang

Zhang

Liu

et al. 2020

Antimicrob Agents Chemother

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Background:Little is known about the influence of extracorporeal membrane oxygenation (ECMO) on the pharmacokinetics (PK) of caspofungin. The aim of this study was to describe population PK of caspofungin in patients with and without ECMO during the postoperative period of lung transplantation (LTx) and investigate covariates influencing caspofungin PK. Methods:We compared ECMO patients with non-ECMO patients, and patients before and after ECMO weaning as self-controls, to analyzed changes in caspofungin PK. Eight serial blood samples were collected from each patient for PK analysis. The population PK of caspofungin was described using non-linear mixed effects modeling. Results:Twelve ECMO and 7 non-ECMO lung transplant recipients were enrolled in this study .None of patients received renal replacement therapy during any part of the study period. The PK of caspofungin was best described by a two-compartment model. There were no significant difference in the PK parameters and concentrations of caspofungin among the ECMO, non-ECMO, and self-control group. In the final covariate model, we found that there was a significant association between the male gender and increased distribution volume, that a higher Sequential Organ Failure Assessment score was related to an increase in intercompartmental clearance, and that a longer operative time was related to an increase in clearance and the volume of distribution. Conclusion:ECMO did not have a significant impact on the PK of caspofungin in patients after LTx. Some factors were identified as statistically significant covariates related to the PK of caspofungin ; however, their impact on clinical practice of caspofungin needs to be investigated further in more studies.

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“…Additionally, degree of pulmonary bypass during ECMO may decrease the amount of liposomal amphotericin B delivered to lungs 5. As liposomal amphotericin B is highly lipophilic and protein bound, there is potential for sequestration within ECMO circuit 5–7…”

Section: Discussionmentioning

confidence: 99%