ASAP ECMO: antibiotic, sedative and analgesic pharmacokinetics during extracorporeal membrane oxygenation: a multi-centre study to optimise drug therapy during ECMO

Shekar, Kiran, Roberts, Jason A., Welsh, Susan, Buscher, Hergen, Rudham, Sam, Burrows, Fay, Ghassabian, Sussan, Wallis, Steven C., Levkovich, Bianca, Pellegrino, Vin, McGuiness, Shay, Parke, Rachael, Gilder, Eileen, Barnett, Adrian G., Walsham, James, Mullany, Daniel V., Fung, Yoke L., Smith, Maree T. and Fraser, John F. (2012) ASAP ECMO: antibiotic, sedative and analgesic pharmacokinetics during extracorporeal membrane oxygenation: a multi-centre study to optimise drug therapy during ECMO. BMC Anesthesiology, 12 29.1-29.9. doi:10.1186/1471-2253-12-29


Author Shekar, Kiran
Roberts, Jason A.
Welsh, Susan
Buscher, Hergen
Rudham, Sam
Burrows, Fay
Ghassabian, Sussan
Wallis, Steven C.
Levkovich, Bianca
Pellegrino, Vin
McGuiness, Shay
Parke, Rachael
Gilder, Eileen
Barnett, Adrian G.
Walsham, James
Mullany, Daniel V.
Fung, Yoke L.
Smith, Maree T.
Fraser, John F.
Title ASAP ECMO: antibiotic, sedative and analgesic pharmacokinetics during extracorporeal membrane oxygenation: a multi-centre study to optimise drug therapy during ECMO
Journal name BMC Anesthesiology   Check publisher's open access policy
ISSN 1471-2253
Publication date 2012-11-28
Year available 2012
Sub-type Article (original research)
DOI 10.1186/1471-2253-12-29
Open Access Status DOI
Volume 12
Start page 29.1
End page 29.9
Total pages 9
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Subject 2703 Anesthesiology and Pain Medicine
Abstract Background: Given the expanding scope of extracorporeal membrane oxygenation (ECMO) and its variable impact on drug pharmacokinetics as observed in neonatal studies, it is imperative that the effects of the device on the drugs commonly prescribed in the intensive care unit (ICU) are further investigated. Currently, there are no data to confirm the appropriateness of standard drug dosing in adult patients on ECMO. Ineffective drug regimens in these critically ill patients can seriously worsen patient outcomes. This study was designed to describe the pharmacokinetics of the commonly used antibiotic, analgesic and sedative drugs in adult patients receiving ECMO.
Formatted abstract
Background: Given the expanding scope of extracorporeal membrane oxygenation (ECMO) and its variable impact on drug pharmacokinetics as observed in neonatal studies, it is imperative that the effects of the device on the drugs commonly prescribed in the intensive care unit (ICU) are further investigated. Currently, there are no data to confirm the appropriateness of standard drug dosing in adult patients on ECMO. Ineffective drug regimens in these critically ill patients can seriously worsen patient outcomes. This study was designed to describe the pharmacokinetics of the commonly used antibiotic, analgesic and sedative drugs in adult patients receiving ECMO.

Methods: This is a multi-centre, open-label, descriptive pharmacokinetic (PK) study. Eligible patients will be adults treated with ECMO for severe cardiac and/or respiratory failure at five Intensive Care Units in Australia and New Zealand. Patients will receive the study drugs as part of their routine management. Blood samples will be taken from indwelling catheters to investigate plasma concentrations of several antibiotics (ceftriaxone, meropenem, vancomycin, ciprofloxacin, gentamicin, piperacillin-tazobactum, ticarcillin-clavulunate, linezolid, fluconazole, voriconazole, caspofungin, oseltamivir), sedatives and analgesics (midazolam, morphine, fentanyl, propofol, dexmedetomidine, thiopentone). The PK of each drug will be characterised to determine the variability of PK in these patients and to develop dosing guidelines for prescription during ECMO.

Discussion: The evidence-based dosing algorithms generated from this analysis can be evaluated in later clinical studies. This knowledge is vitally important for optimising pharmacotherapy in these most severely ill patients to maximise the opportunity for therapeutic success and minimise the risk of therapeutic failure.
Keyword ECMO
Pharmacokinetics
Pharmacodynamics
Antibiotics
Sedatives
Analgesics
Therapeutic failure
Drug toxicity
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID 569917
Institutional Status UQ
Additional Notes Article 29

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
School of Pharmacy Publications
 
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Created: Fri, 18 Jan 2013, 20:36:26 EST by Professor Maree Smith on behalf of School of Pharmacy