Machines that help machines to help patients: optimising antimicrobial dosing in patients receiving extracorporeal membrane oxygenation and renal replacement therapy using dosing software.
Machines that help machines to help patients: optimising antimicrobial dosing in patients receiving extracorporeal membrane oxygenation and renal replacement therapy using dosing software.
复制标题
DOI：
10.1007/s00134-022-06847-2
复制
发表时间：
2022-10
影响因子：
38.9
通讯作者：
Abdul-Aziz, Mohd H.
中科院分区：
文献类型：
--
作者：
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.
关键词：
终末器官衰竭的重症监护室（ICU）患者将需要专门的机器或体外治疗来支持衰竭的器官，否则会导致死亡。重症急性肾损伤的ICU患者可能需要肾脏替代治疗（RRT），以清除体内液体和废物，重度心肺功能衰竭的患者需要体外膜肺氧合（ECMO），以维持充足的氧气输送，同时评估和管理潜在的病理学。ECMO和RRT机器的存在可以进一步增加危重疾病期间现有的药代动力学（PK）变化。在ECMO和RRT期间，已报告了许多重要药物的表观分布容积（Vd）和药物清除率（CL）的显著变化。传统的抗菌剂给药方案很少考虑这些变化的影响，因此，在接受ECMO和/或RRT的重症患者中不太可能实现有效的抗菌剂暴露。因此，需要深入了解ECMO和/或RRT期间的潜在PK变化，以告知接受ECMO和/或RRT的患者的抗菌剂给药策略。在本叙述性综述中，我们旨在讨论ECMO和RRT在接受这些体外治疗时对抗菌药物PK和抗菌药物给药要求的潜在影响。还审查并强调了治疗药物监测（TDM）和给药软件的潜在益处，以促进接受ECMO和/或RRT的危重患者的抗菌治疗。在线版本包含补充材料，可通过10.1007/s 00134 -022-06847-2获得。
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. The online version contains supplementary material available at 10.1007/s00134-022-06847-2.
登录
查看更多内容
影响因子：
1.2
作者：
Bhatt-Mehta, V;Annich, G
通讯作者：
Annich, G
影响因子：
2.5
作者：
DAGAN, O;KLEIN, J;KOREN, G
通讯作者：
KOREN, G
影响因子：
4.9
作者：
Cheng, Vesa;Abdul-Aziz, Mohd H.;Roberts, Jason A.
通讯作者：
Roberts, Jason A.
DOI：
10.1016/j.ijantimicag.2021.106466
发表时间：
2021-11-24
影响因子：
10.8
作者：
Cheng, Vesa;Abdul-Aziz, Mohd H.;Fraser, John F.
通讯作者：
Fraser, John F.
影响因子：
4.9
作者：
Cheng, Vesa;Abdul-Aziz, Mohd H.;Roberts, Jason A.
通讯作者：
Roberts, Jason A.