Drug therapies in neonates and children during extracorporeal membrane oxygenation (ECMO)
@inproceedings{Wildschut2010DrugTI, title={Drug therapies in neonates and children during extracorporeal membrane oxygenation (ECMO)}, author={Enno Diederik Wildschut}, year={2010} }
__Abstract__
Extracorporeal life support (ECLS) or extra corporeal membrane oxygenation (ECMO)
is a technique for providing life support in severe but potentially reversible cardiorespiratory
failure in patients with an expected mortality greater than 80%.
First pioneered in cardiopulmonary bypass during cardiac surgery, ECLS has been used
as prolonged cardiopulmonary support in neonates since 1976. It has been shown to
have a survival benefit in neonates and adults. Increasingly ECMO…
3 Citations
Pediatric Cardiovascular Drug Dosing in Critically Ill Children and Extracorporeal Membrane Oxygenation
- Medicine, BiologyJournal of cardiovascular pharmacology
- 2011
Research efforts should focus on evaluating the PK of drugs in patients on ECMO to avoid therapeutic failures or unnecessary toxicities, and definitive dosing recommendations are not plausible.
Effect of hypothermia and extracorporeal life support on drug disposition in neonates.
- Medicine, BiologySeminars in fetal & neonatal medicine
- 2013
Innovative clinical trial design for pediatric therapeutics
- MedicineExpert review of clinical pharmacology
- 2011
Until approximately 15 years ago, sponsors rarely included children in the development of therapeutics, but national research networks in Europe and the USA are beginning to address some of the gaps in pediatric therapeutics using novel clinical trial designs.
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Extracorporeal membrane oxygenation (ECMO) is used in the treatment of 13 moribund infants (including 9 neonates), with 4 survivors (3 neonates).
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The literature published to date on the pharmacokinetic changes associated with ECMO provide preliminary support for dosage adjustment; however, more research is needed to identify optimal administration strategies for this patient population.
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It is suggested that there is enhanced hemolysis during combined ECMO and CRRT compared with ECMO alone, and the clinical impact of increasedhemolysis on renal function in patients receiving ECMO with or without CRRT remains to be determined.
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This study shows that the introduction of a CRRT device into the ECMO circuit is a safe and effective technique that improves fluid balance, increases filter life, and does not cause complications.
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It is concluded that gentamicin and probably other aminoglycosides should be given at dose rates about 25% lower than usual and at longer dosing intervals in patients undergoing ECMO therapy.
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In comparison with previously published data, the neonates undergoing ECMO in this study demonstrated a much larger volume of distribution, a lower clearance, and consequently a longer vancomycin half-life, suggesting alterations in the pharmacokinetics of vancomYcin in infants on ECMO.
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