Vancomycin population pharmacokinetics during extracorporeal membrane oxygenation therapy: a matched cohort study

Donadello, Katia, Roberts, Jason A., Cristallini, Stefano, Beumier, Marjorie, Shekar, Kiran, Jacobs, Frederique, Belhaj, Asmae, Vincent, Jean-Louis, de Backer, Daniel and Taccone, Fabio Silvio (2014) Vancomycin population pharmacokinetics during extracorporeal membrane oxygenation therapy: a matched cohort study. Critical Care, 18 632: 1-10. doi:10.1186/s13054-014-0632-8

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Author Donadello, Katia
Roberts, Jason A.
Cristallini, Stefano
Beumier, Marjorie
Shekar, Kiran
Jacobs, Frederique
Belhaj, Asmae
Vincent, Jean-Louis
de Backer, Daniel
Taccone, Fabio Silvio
Title Vancomycin population pharmacokinetics during extracorporeal membrane oxygenation therapy: a matched cohort study
Journal name Critical Care   Check publisher's open access policy
ISSN 1466-609X
Publication date 2014-11-22
Year available 2014
Sub-type Article (original research)
DOI 10.1186/s13054-014-0632-8
Open Access Status DOI
Volume 18
Issue 632
Start page 1
End page 10
Total pages 10
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2015
Language eng
Formatted abstract

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).


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.


We compared 11 patients treated with ECMO with 11 well-matched controls. Drug dosing was similar between groups. The median interquartile range (IQR) vancomycin concentrations in ECMO and non-ECMO patients were 51 (28 to 71) versus 45 (37 to 71) mg/L at 4 hours; 23 (16 to 38) versus 29 (21 to 35) mg/L at 12 hours; 20 (12 to 36) versus 23 (17¿28) mg/L at 24 hours (ANOVA, P =0.53). Median (ranges) volume of distribution (Vd) was 99.3 (49.1 to 212.3) and 92.3 (22.4 to 149.4) L in ECMO and non-ECMO patients, respectively, and clearance 2.4 (1.7 to 4.9) versus 2.3 (1.8 to 3.6) L/h (not significant). Insufficient drug concentrations (that is drug levels <20 mg/dL) were more common in the ECMO group. The pharmacokinetic model (non-linear mixed effects modeling) was prospectively validated in five additional ECMO-treated patients over a 6-month period. Linear regression analysis comparing the observed concentrations and those predicted using the model showed good correlation (r2 of 0.67; P <0.001).


Vancomycin concentrations were similar between ECMO and non-ECMO patients in the early phase of therapy. ECMO treatment was not associated with significant changes in Vd and drug clearance compared with the control patients.
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Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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