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Review
. 2022 Oct;48(10):1338-1351.
doi: 10.1007/s00134-022-06847-2. Epub 2022 Aug 23.

Machines that help machines to help patients: optimising antimicrobial dosing in patients receiving extracorporeal membrane oxygenation and renal replacement therapy using dosing software

Jason A Roberts  1   2   3   4 , Rinaldo Bellomo  5   6   7   8 , Menino O Cotta  9 , Birgit C P Koch  10 , Haifa Lyster  11   12 , Marlies Ostermann  13 , Claire Roger  14   15 , Kiran Shekar  16   17   18   19 , Kevin Watt  20   21 , Mohd H Abdul-Aziz  9
Affiliations
Review

Machines that help machines to help patients: optimising antimicrobial dosing in patients receiving extracorporeal membrane oxygenation and renal replacement therapy using dosing software

Jason A Roberts et al. Intensive Care Med. 2022 Oct.

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.

Keywords: Antimicrobial; Dosing software; Extracorporeal membrane oxygenation; Pharmacokinetics; Renal replacement therapy; Therapeutic drug monitoring.

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Conflict of interest statement

All authors declare no conflict of interest in relation to this paper.

Figures

Fig. 1
Fig. 1
Future approach to therapeutic drug monitoring and use of dosing software in the ICU
See this image and copyright information in PMC

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