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.; Welch, Susan; Buscher, Hergen; Rudham, Sam; Burrows, Fay; Ghassabian, Sussan; Wallis, Steven C.; Levkovich, Bianca; Pellegrino, Vin; McGuinness, Shay; Parke, Rachael; Gilder, Eileen; Barnett, Adrian; Walsham, James; Mullany, Daniel; Fung, Yoke Lin; Smith, Maree T.; Fraser, John F.

doi:10.1186/1471-2253-12-29

Cited by 94 publications

(81 citation statements)

References 36 publications

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“…Volume of distribution, protein binding, physico-chemical characteristics and physiologic changes all influence how particular medications will be influenced by the ECMO circuit [14]. There is significant sequestration of propofol, opioids and benzodiazepines in the circuit [13].…”

Section: Discussionmentioning

confidence: 99%

Veno-Venous Extracorporeal Membrane Oxygenation: Anesthetic Management for Massive Intracranial Hemorrhage in H1N1 Infection

Kraus¹,

Weis²,

Alwardt³

et al. 2015

OJAnes

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Background: Extracorporeal membrane oxygenator (ECMO) use is dramatically increasing in recent years. This case report describes a patient on veno-venous (VV) ECMO for H1N1 who underwent emergent craniotomy twice for intracranial hemorrhage. Case presentation: A 38-year-old male presented to a community hospital for worsening shortness of breath. He had experienced cough, malaise and fatigue for two weeks prior to presentation. On arrival, his arterial oxygen saturation was 64%. He was placed on oxygen via non-rebreather mask and started on Tamiflu plus antibiotics. He was intubated for worsening respiratory failure. Despite maximal ventilator settings, the arterial oxygen saturation was approximately 90%. He was placed in the prone position and nitric oxide was initiated. Severe acute respiratory distress syndrome (ARDS) secondary to influenza was diagnosed by viral PCR, clinical presentation, and diagnostic imaging. Within 24 hours of his intubation, a decision was made to initiate veno-venous (V-V) ECMO for respiratory support. Five days following the initiation of ECMO, asymmetric pupils and a nonreactive right pupil were noted. A massive right frontal intraparenchymal hemorrhage with midline shift and downward uncal herniation was found on computed tomography (CT). A decision was made to surgically intervene. He was taken to the operating room for immediate right frontal craniotomy and clot evacuation under general anesthesia. Conclusion: With the dramatic increase in ECMO use, anesthesiologists are encountering patients on ECMO in the operating room with more frequency. When the situation does arise, it is imperative that the anesthesiologist is knowledgeable about ECMO and how to appropriately administer anesthesia for these critically ill patients. Challenges M. Kraus et al. 252 confronting the anesthesiologist with ECMO patients include managing bleeding or coagulopathy, ventilation and oxygenation, volume status, transporting and positioning these patients, and altered pharmacokinetics of anesthetic drugs.

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Section: Discussionmentioning

confidence: 99%

Veno-Venous Extracorporeal Membrane Oxygenation: Anesthetic Management for Massive Intracranial Hemorrhage in H1N1 Infection

Kraus¹,

Weis²,

Alwardt³

et al. 2015

OJAnes

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“…Zapotrzebowanie na środki sedatywne jest olbrzymie i znacznie przekracza konwencjonalne dawki [52]. Farmakokinetyka środków sedatywnych, ale także analgetyków i antybiotyków jest zaburzona w takim stopniu, że stało się to impulsem do przeprowadzenia badań, w tym również w odniesieniu do deksmedetomidyny [53,54]. Z drugiej strony, pacjenci poddani ECMO wymagają głębszej sedacji, ponieważ próby spontanicznego oddechu, szczególnie w obecności hipowolemii, powodują zasysanie kaniul z gwałtownym zmniejszeniem liczby obrotów pompy napędzającej układ ECMO i znaczącym pogorszeniem oksygenacji.…”

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Zastosowanie deksmedetomidyny na oddziale intensywnej terapii dorosłych

Wujtewicz

Maciejewski²,

Misiołek³

et al. 2014

Anaesthesiol Intensive Ther

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Sedation and analgesia, which are universally used in intensive care units (ICUs), provide patients with comfort and safety. The current trends aim at light sedation; the objective is to ensure the minimal sedation level for improving patients' autonomy and enabling the professional staff to assess the patients' neurological status and cognitive functions. Reports in the literature have indicated that a sedative or an entire sedation procedure can affect cognitive processes, the duration of mechanical ventilation and treatment outcomes in critically ill patients. At present, special attention is given to post-sedation delirium. Although sedatives differ in their uptake points, which can influence the quality of sedation, their common characteristic is substantial impairment of cognitive functions, memory and respiration. Alpha 2-adrenergic receptor agonists, which comprise a novel group of agents, are used frequently for sedation. One of these medications is dexmedetomidine, which is designed to sedate adult ICU patients who exhibit a score ≥ -3 according to the Richmond Agitation-Sedation Scale. Recent studies comparing the use of dexmedetomidine and the other sedative agents that are most commonly administered in ICUs demonstrated that the former largely fulfils the expectations of intensivists.

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“…This platform is also being utilised by our group to systemically investigate the effects of ECMO on pathophysiology, inflammation, coagulation, pulmonary and other organ functions, and nutrient disposition. An international multi-centre, population PK study [5] is currently recruiting, and vital PK data will soon be available for 18 important antibiotic, sedative and analgesic drugs commonly prescribed during ECMO. This may lead to the generation of evidence-based guidelines for dosing of the above drugs during ECMO.…”

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confidence: 99%