Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood

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• 作者：Florian Lemaitre (1) (2) (3) (4)
  Nesrine Hasni (1)
  Pascal Leprince (6) (7)
  Emmanuel Corvol (7)
  Ghassen Belhabib (1)
  Pierre Fill芒tre (2) (3) (4)
  Charles-Edouard Luyt (5) (6)
  Cyril Leven (2) (3) (4)
  Robert Farinotti (1)
  Christine Fernandez (1) (8)
  Alain Combes (5) (6)
  
  1. Faculty of Pharmacy ; EA4123 Barri猫res physiologiques et r茅ponses th茅rapeutiques ; Paris Sud University ; Ch芒tenay-Malabry ; France
  2. Department of Clinical and Biological Pharmacology and Pharmacovigilance ; Pharmacoepidemiology and Drug Information Center ; Rennes University Hospital ; Rennes ; France
  3. Faculty of Medicine ; Laboratory of Experimental and Clinical Pharmacology ; Rennes 1 University ; Rennes ; France
  4. Inserm ; CIC-P 1414 Clinical Investigation Center ; Rennes ; France
  6. Paris 6 University Pierre et Marie Curie ; 91-105 Boulevard de l鈥橦么pital ; 75013 ; Paris ; France
  7. Cardiovascular Surgery department ; Piti茅-Salp锚tri猫re Hospital ; Assistance Publique H么pitaux de Paris ; AP-HP ; 47-83 Boulevard de l鈥橦么pital ; 75013 ; Paris ; France
  5. Service de R茅animation M茅dicale ; Groupe Hospitalier Piti茅-Salp锚tri猫re ; iCAN ; Institute of Cardiometabolism and Nutrition ; 47 ; Boulevard de l鈥橦么pital ; 75651 ; Paris ; Cedex 13 ; France
  8. Pharmacy Department ; Saint-Antoine Hospital ; Assistance Publique H么pitaux de Paris ; AP-HP ; 184 rue du faubourg Saint-Antoine ; 75012 ; Paris ; France
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：476 KB
• 参考文献：1. Mulla H, Lawson G, von Anrep C, Burke MD, Upton DU, Firmin RK, et al. In vitro evaluation of sedative drug losses during extracorporeal membrane oxygenation. Perfusion. 2000;15:21鈥?. dx.doi.org/10.1177/026765910001500104" target="_blank" title="It opens in new window">CrossRef
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  4. Leprince P, Aubert S, Bonnet N, Rama A, L茅ger P, Bors V, et al. Peripheral extracorporeal membrane oxygenation (ECMO) in patients with posttransplant cardiac graft failure. Transplant Proc. 2005;37:2879鈥?0. dx.doi.org/10.1016/j.transproceed.2005.05.018" target="_blank" title="It opens in new window">CrossRef
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  6. Wildschut ED, Ahsman MJ, Allegaert K, Mathot RAA, Tibboel D. Determinants of drug absorption in different ECMO circuits. Intensive Care Med. 2010;36:2109鈥?6. dx.doi.org/10.1007/s00134-010-2041-z" target="_blank" title="It opens in new window">CrossRef
  7. Lemaitre F, Luyt CE, Roullet-Renoleau F, Nieszkowska A, Zahr N, Corvol E, et al. Impact of extracorporeal membrane oxygenation and continuous venovenous hemodiafiltration on the pharmacokinetics of oseltamivir carboxylate in critically ill patients with pandemic (H1N1) influenza. Ther Drug Monit. 2012;34:171鈥?. dx.doi.org/10.1097/FTD.0b013e318248672c" target="_blank" title="It opens in new window">CrossRef
  8. Lemaitre F, Luyt CE, Roullet-Renoleau F, Nieszkowska A, Zahr N, Fernandez C, et al. Oseltamivir carboxylate accumulation in a patient treated by haemodiafiltration and extracorporeal membrane oxygenation. Intensive Care Med. 2010;36:1273鈥?. dx.doi.org/10.1007/s00134-010-1882-9" target="_blank" title="It opens in new window">CrossRef
  9. Spriet I, Annaert P, Meersseman P, Hermans G, Meersseman W, Verbesselt R, et al. Pharmacokinetics of caspofungin and voriconazole in critically ill patients during extracorporeal membrane oxygenation. J Antimicrob Chemother. 2009;63:767鈥?0. dx.doi.org/10.1093/jac/dkp026" target="_blank" title="It opens in new window">CrossRef
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  12. Shekar K, Roberts JA, Ghassabian S, Mullany DV, Wallis SC, Smith MT, et al. Altered antibiotic pharmacokinetics during extracorporeal membrane oxygenation: cause for concern? J Antimicrob Chemother. 2013;68:726鈥?. dx.doi.org/10.1093/jac/dks435" target="_blank" title="It opens in new window">CrossRef
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  14. Drug Bank: Midazolam (DB00683). drugbank.ca/drugs/DB00683" class="a-plus-plus">www.drugbank.ca/drugs/DB00683. Accessed 1 Oct 2014.
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  16. Drug Bank: Vancomycin (DB00512). drugbank.ca/drugs/DB00512" class="a-plus-plus">www.drugbank.ca/drugs/DB00512. Accessed 1 Oct 2014.
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction As a result of drug sequestration and increased volume of distribution, the extracorporeal membrane oxygenation (ECMO) procedure might lead to a decrease in drug concentrations during a patient鈥檚 treatment. The aim of this study was to evaluate sedative, antibiotic and immunosuppressive drug loss in ECMO circuit using ex-vivo and in-vitro experiments. Methods Blood concentrations of propofol, midazolam, cyclosporine and vancomycin were measured in an ex-vivo ECMO circuit primed with whole human blood, and compared to controls stored in polypropylene tubes. In vitro experiments were also conducted to further explore the role of temperature, oxygen exposure and polyvinylchloride surfaces on propofol loss in the ECMO circuit. Results Propofol concentration decreased rapidly; 70% of its baseline concentration was lost after only 30聽minutes, and only 11% remained after five hours (P P鈥?鈥?.01 versus control). Alternatively, cyclosporine concentration remained stable for the five first hours, then decreased to 78% and 73% of the baseline value after 24聽hours and 48聽hours, (P鈥?鈥?.35 versus control). Lastly, vancomycin concentration remained stable in the ECMO circuit for the 48-hour experimental protocol. Conclusions We observed important losses of propofol and midazolam, while cyclosporine concentration decreased slowly and moderately, and vancomycin concentration remained unchanged in the ex-vivo ECMO circuit primed with whole human blood. These data might help intensive care unit physicians planning clinical trials with a final objective to better adapt doses of these drugs while treating critically ill ECMO patients.