Effect of extracorporeal membrane oxygenation on the new vancomycin dosing regimen in critically Ill patients receiving continuous venovenous hemofiltration
Journal
Therapeutic Drug Monitoring
Journal Volume
40
Journal Issue
3
Pages
310-314
Date Issued
2018
Author(s)
Abstract
Background: The optimal dosing regimen of vancomycin for critically ill patients receiving continuous venovenous hemofiltration (CVVH) remains controversial, not to mention those with concurrent use of extracorporeal membrane oxygenation (ECMO). We aimed to determine if a new dosing regimen can achieve the target vancomycin trough concentration (Ctrough) of 10-20 mcg/mL in patients receiving CVVH with or without ECMO. Methods: We conducted a retrospective study by enrolling patients who received vancomycin while undergoing CVVH. The vancomycin dosing regimen was 15-20 mg/kg as the loading dose and 7.5 mg/kg every 12 hours as the maintenance doses. Serum concentration was determined after at least 4 doses of vancomycin were given. Results: A total of 38 patients were enrolled, of which 21 were also on ECMO. The ultrafiltration rate of CVVH was 30.6 ± 5.5 mL·kg-1·h-1 with the Ctrough of 14.7 ± 3.5 mcg/mL. Ctrough was within the target range in 82% of patients. All CVVH-only patients achieved the target concentration, whereas only 76.2% of those with concurrent ECMO did (P = 0.031). Conclusions: All patients receiving CVVH achieved the target Ctrough with this new dosing regimen, but those with concurrent ECMO did not. Ctrough must be more closely monitored in patients using ECMO simultaneously. Copyright ? 2018 Wolters Kluwer Health, Inc. All rights reserved.
Subjects
Continuous venovenous hemofiltration (CVVH); Critical care; Extracorporeal membrane oxygenation (ECMO); Vancomycin
SDGs
Other Subjects
vancomycin; antiinfective agent; vancomycin; adult; Article; clinical article; continuous hemofiltration; critically ill patient; drug blood level; drug dose regimen; extracorporeal oxygenation; female; human; loading drug dose; male; middle aged; patient monitoring; priority journal; retrospective study; trough concentration; ultrafiltration; aged; blood; critical illness; dose response; drug administration; drug monitoring; extracorporeal oxygenation; hemofiltration; trends; Adult; Aged; Anti-Bacterial Agents; Critical Illness; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Monitoring; Extracorporeal Membrane Oxygenation; Female; Hemofiltration; Humans; Male; Middle Aged; Retrospective Studies; Vancomycin
Type
journal article