The pharmacokinetics (PK) of several drugs including antimicrobials might be highly altered during extracorporeal membrane oxygenation (ECMO) therapy. We present the change of voriconazole (VRC) PK during ECMO in a critically ill patient who received intravenous VRC at a maintenance dose of 200 mg every 12 h for empirical antifungal therapy. Two PK profiles were drawn before and after the initiation of ECMO therapy. Though the trough levels (both and ) with ECMO were slightly lower than that without ECMO (12.58 and 12.84 14.02 μg/mL), the peak levels and the area under the concentration-time curve from 0 h to 6 h (AUC) were comparable (16.36 16.06 μg/mL and 90.78 91.45 μg·h/mL, respectively), indicating that VRC plasma exposure during ECMO therapy did not greatly decrease in our patient. The circuit factors including the type of membrane should be taken into account to further identify the effects of ECMO on the PK of VRC.
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http://dx.doi.org/10.1080/1120009X.2021.2014725 | DOI Listing |
Eur J Heart Fail
January 2025
Department for Internal Medicine and Cardiology, Technische Universität Dresden, Heart Centre Dresden, University Hospital, Dresden, Germany.
Aims: This study aimed to investigate incidence and predictors of weaning failure and in-hospital death after successful weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS).
Methods And Results: Overall, 685 patients with CS treated with VA-ECMO from 23 tertiary care centres in 7 countries were analysed (median age 57 [interquartile range 49-66] years, 542 [79.1%] male, median lactate 7.
J Intensive Med
October 2024
Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain.
Recently, there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation (NIV) and its potential influence on the outcome. Various studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa, reduced mucociliary clearance, increased airway resistance, reduced epithelial cell function, increased inflammation, sloughing of tracheal epithelium, and submucosal inflammation. With the Coronavirus Disease 2019 pandemic, using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among clinicians.
View Article and Find Full Text PDFPort J Card Thorac Vasc Surg
October 2024
Intensive Care Medicine, Centro Hospitalar e Universitário São João, Porto, Portugal; Faculty of Medicine, Porto University, Portugal.
Background And Objectives: The optimal management of high-risk and intermediate-high-risk Pulmonary Embolism (PE) is a matter of ongoing debate. This paper aims to assess the short and long-term clinical outcomes associated with different treatment approaches for high-risk and intermediate-high-risk PE within an Intensive Care Unit (ICU) and identify potential areas for improvement.
Methods: We conducted a retrospective analysis of patients admitted to an ICU with high and intermediate-high-risk PE between January 2018 and December 2023.
BMC Pediatr
January 2025
Division of Neonatology, Pediatric Intensive Care & Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
Background: Lung ultrasound scoring is a validated tool for assessing lung pathology. However, existing scoring systems typically overlook the size of consolidations, limiting their accuracy in certain clinical scenarios.
Case Presentation: We describe the first application of adding the maximum consolidation depth in centimeters (cm) to the conventional score.
BMC Anesthesiol
January 2025
Department of Nephrology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.
Introduction: Acute kidney injury (AKI) is a common complication of acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) in patients receiving extracorporeal membrane oxygenation (ECMO) support, leading to requirement of continuous renal replacement therapy (CRRT) in 70% of ECMO patients. Parallel arrangement of CRRT and ECMO circuits is common in adult patients. However, CRRT may also be integrated directly into the ECMO circuit.
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