The effect of veno-venous ECMO on the pharmacokinetics of Ritonavir, Darunavir, Tenofovir and Lamivudine.

Introduction: To our knowledge, there is no published data on the pharmacokinetic (PK) profile of antiretroviral (ART) drugs on patients undergoing extracorporeal membrane oxygenation (ECMO) therapy. We present PK analyses of Ritonavir, Darunavir, Lamivudine and Tenofovir in a patient with HIV who required veno-venous ECMO (VV ECMO).

Methods: Plasma concentrations for Ritonavir, Darunavir, Tenofovir and Lamivudine were obtained while the patient was on ECMO following pre-emptive dose adjustments.

Oxygenation via a Biventricular Assist Device for Emergency Airway Management.

A 56-year-old man receiving mechanical circulatory support via a biventricular assist device suffered an airway emergency secondary to bleeding into the airway. An improvised solution to gain control of the airway in the short term was devised, and an oxygenator was inserted into the circuit, providing an alternative means of gas exchange while definitive control of the airway was achieved. This case changed practice in our institution, where we now make contingency plans for emergency oxygenator insertion into the circuits of all patients with a biventricular assist device who show any sign of airway hemorrhage.

Chronic mould exposure as a risk factor for severe community acquired pneumonia in a patient requiring extra corporeal membrane oxygenation.

A previously fit and well man developed acute respiratory failure due to environmental mould exposure from living in damp rental accommodation. Despite aggressive intensive care management he rapidly deteriorated and required respiratory and cardiac Extracorporeal Membrane Oxygenation. We hypothesize that poor domiciliary conditions may make an underestimated contribution to community respiratory disease.

The effect of increasing doses of norepinephrine on tissue oxygenation and microvascular flow in patients with septic shock.

Objective: To investigate the effect of escalating doses of norepinephrine, aimed at achieving incremental increases in mean arterial pressure (MAP), on microvascular flow and tissue oxygenation in patients with septic shock.

Design: Single-center interventional study.

Setting: University hospital intensive care unit.