Therapeutic Drug Monitoring of Vancomycin in Pediatric Patients With Extracorporeal Membrane Oxygenation Support

Abstract

In patients without AKI or RRT, Vd of vancomycin was similar and CL was lower compared to pediatric critically ill patients without ECMO. Treatment could be started at 40 mg/kg/day every 6 hours. In patients with AKI, the use of lower doses should be used.

Pharmacokinetics Alterations in Critically Ill Pediatric Patients on Extracorporeal Membrane Oxygenation: A Systematic Review

“…These variations included differences in route of administration (intravenous or oral), dosages of medications, administration method (bolus, intermittent dosing, or continuous infusion), and usage of co-medications. Twelve of the 41 studies (29.3%) included patients on continuous renal replacement therapy (CRRT) ( 15 , 16 , 19 , 20 , 26 – 28 , 30 , 31 , 33 , 35 , 42 ). Renal and liver functions were not consistently reported in majority of the studies.…”

“…Renal and liver functions were not consistently reported in majority of the studies. Specifically, baseline renal functions were reported only in 19 out of 41 studies (46.3%) ( 8 – 11 , 20 – 24 , 28 , 30 – 33 , 37 , 39 , 40 , 43 , 46 ) while only 12 out of 41 studies (29.3%) reported baseline liver functions ( 8 , 10 , 21 , 24 , 28 , 30 – 32 , 40 , 42 , 43 , 46 ). In addition, 17 studies (41%) did not report the type of ECMO used ( 11 – 13 , 16 – 19 , 22 , 25 – 27 , 30 , 31 , 38 , 41 , 44 , 47 ).…”

“…In addition, 17 studies (41%) did not report the type of ECMO used ( 11 – 13 , 16 – 19 , 22 , 25 – 27 , 30 , 31 , 38 , 41 , 44 , 47 ). Of those that reported the type of ECMO used, 10 studies (24%) employed both veno-venous (VV) and venous–arterial (VA) ECMO ( 8 , 14 , 20 , 24 , 32 , 35 , 40 , 42 ) 10 studies (24%) used VA ECMO only ( 9 , 15 , 21 , 23 , 28 , 37 , 39 , 43 , 45 , 46 ), and the remaining four studies (10%) used VV ECMO only ( 29 , 33 , 34 , 36 ). Of 41 studies, 21 studies (51.2%) specified the type of oxygenator used, with Avecor 0800 oxygenator (Avecor Cardiovascular Inc.) being the most commonly used ( 8 , 10 , 15 , 17 , 21 – 24 , 28 , 31 , 34 , 36 – 38 , 40 , 42 – 46 , 48 ).…”

“…Of the 23 drugs studied, V d values were reported for 16 drugs (70%) ( 8 – 14 , 18 , 20 – 24 , 26 , 28 , 30 – 40 , 42 , 43 , 47 , 50 ) with the remaining seven other drugs having only clearance values reported without V d values ( 15 – 17 , 19 , 27 , 29 , 44 – 46 ). Relative to non-ECMO controls, significant alterations in V d were observed in pediatric patients supported on ECMO for 11 of 16 studied drugs ( Table 2 ).…”

“…Of note, vancomycin was studied in six separate studies, only one of which included a non-ECMO comparator group ( 22 ) while the remaining five did not ( 20 , 21 , 23 , 24 , 50 ) Although a trend was observed toward smaller V d of vancomycin relative to non-ECMO controls, the difference did not reach statistical significance in the study by Buck ( 22 ) However, when the V d values were compared against historical controls, increased V d was observed compared to pediatric patients not on ECMO ( 20 , 21 , 23 , 24 , 50 ). In addition, we did not identify any significant correlation between lipophilicity (as measured by log P ) of drugs and changes in V d attributable to ECMO ( Supplementary Table 1 ).…”