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Title: Machines that help machines to help patients: optimising antimicrobial dosing in patients receiving extracorporeal membrane oxygenation and renal replacement therapy using dosing software.
Austin Authors: Roberts, Jason A;Bellomo, Rinaldo ;Cotta, Menino O;Koch, Birgit C P;Lyster, Haifa;Ostermann, Marlies;Roger, Claire;Shekar, Kiran;Watt, Kevin;Abdul-Aziz, Mohd H
Affiliation: Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia..
Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, QLD, 4029, Australia..
Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia..
Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia..
Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia..
Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia..
Department of Critical Care, The University of Melbourne, Melbourne, Australia..
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia..
Intensive Care
Herston Infectious Diseases (HeIDI), Metro North Health, Brisbane, QLD, Australia..
Department of Hospital Pharmacy, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands..
Pharmacy Department, Royal Brompton and Harefield Hospitals, London, SW3 6NP, UK..
Department of Critical Care, King's College London, Guy's and St Thomas Hospital, London, SE1 7EH, UK..
Department of Anaesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Place du Professeur Robert Debré, 30 029, Nîmes cedex 9, France..
School of Pharmacy, University of Waterloo, 10 Victoria St S. Kitchener, Waterloo, ON, N2G 1C5, Canada..
Department of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia..
Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France..
Cardiothoracic Transplant Unit, Royal Brompton and Harefield Hospitals, London, SW3 6NP, UK..
UR UM 103 IMAGINE, Faculty of Medicine, University of Montpellier, Nîmes, France..
Department of Paediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA..
Issue Date: 23-Aug-2022
Date: 2022
Publication information: Intensive Care Medicine 2022-10; 48(10): 1338-1351
Abstract: Intensive care unit (ICU) patients with end-organ failure will require specialised machines or extracorporeal therapies to support the failing organs that would otherwise lead to death. ICU patients with severe acute kidney injury may require renal replacement therapy (RRT) to remove fluid and wastes from the body, and patients with severe cardiorespiratory failure will require extracorporeal membrane oxygenation (ECMO) to maintain adequate oxygen delivery whilst the underlying pathology is evaluated and managed. The presence of ECMO and RRT machines can further augment the existing pharmacokinetic (PK) alterations during critical illness. Significant changes in the apparent volume of distribution (Vd) and drug clearance (CL) for many important drugs have been reported during ECMO and RRT. Conventional antimicrobial dosing regimens rarely consider the impact of these changes and consequently, are unlikely to achieve effective antimicrobial exposures in critically ill patients receiving ECMO and/or RRT. Therefore, an in-depth understanding on potential PK changes during ECMO and/or RRT is required to inform antimicrobial dosing strategies in patients receiving ECMO and/or RRT. In this narrative review, we aim to discuss the potential impact of ECMO and RRT on the PK of antimicrobials and antimicrobial dosing requirements whilst receiving these extracorporeal therapies. The potential benefits of therapeutic drug monitoring (TDM) and dosing software to facilitate antimicrobial therapy for critically ill patients receiving ECMO and/or RRT are also reviewed and highlighted.
DOI: 10.1007/s00134-022-06847-2
Journal: Intensive Care Medicine
PubMed URL: 35997793
PubMed URL:
Type: Journal Article
Subjects: Antimicrobial
Dosing software
Extracorporeal membrane oxygenation
Renal replacement therapy
Therapeutic drug monitoring
Appears in Collections:Journal articles

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