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Published on: January 27, 2023
Influence of echinocandin administration on hemodynamic parameters in medical intensive care unit patients: a single
Tobias Lahmer1, Christopher Schnappauf2, Marlena Messer2
1II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany. Tobias.Lahmer@lrz.tu-muenchen.de.
Purpose:
Fungal infections present a constant risk to critically ill and immunocompromised patients. Therefore, treatment guidelines recommend echinocandins as first-line antifungals in critically ill patients to improve patient outcomes. Echinocandins are usually well tolerated; nevertheless, rare adverse events can occur. There are reports of temporary deterioration of hemodynamic parameters during loading doses, especially in critically ill patients. The objective of this study is to analyze the hemodynamic changes during administration of the echinocandin antifungals, caspofungin and anidulafungin, in medical intensive care unit patients.
Methods:
A prospective study in medical ICU patients receiving echinocandins was monitored using single-indicator transpulmonary thermodilution (TPTD). TPTD measurements were performed immediately before, directly after, and 4 h after echinocandins on two following days.
Results:
Mean arterial pressure and also diastolic blood pressure showed significant changes (p < 0.042 and p < 0.007) after echinocandin application in the measurement immediately after application, but not after 4 h. Basic hemodynamic parameters as well as the TPTD-derived cardiac function parameters did not significantly change after echinocandin application at all. In patients with the need for norepinephrine therapy, the vasopressor dose was not statistically significantly altered.
Conclusion:
To conclude, administration of echinocandins in this observed study population is safe, even in severely critically ill patients if application rules of these agents are followed. However, adverse effects could be observed and practitioners should be cognizant of these effects. These observations can be optimized by high-level assessments, such as the pulse contour cardiac output monitoring, and clinicians should continue to be vigilant with cardiac monitoring of patients receiving echinocandin antifungals.
Insights
Echinocandin antifungals, caspofungin and anidulafungin, are generally safe for critically ill patients. While minor hemodynamic changes may occur immediately after administration, overall patient stability is maintained, supporting their use in intensive care units.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Fungal infections pose a significant risk to critically ill and immunocompromised individuals.
- Echinocandins are recommended as first-line antifungal agents for critically ill patients.
- While generally well-tolerated, rare adverse events, including hemodynamic changes, have been reported with echinocandin loading doses.
Purpose of the Study:
- To investigate hemodynamic changes during the administration of echinocandin antifungals (caspofungin and anidulafungin).
- To assess the safety and impact of echinocandins on hemodynamic parameters in medical intensive care unit (ICU) patients.
Main Methods:
- Prospective study involving medical ICU patients receiving echinocandins.
- Hemodynamic monitoring using single-indicator transpulmonary thermodilution (TPTD).
- TPTD measurements taken before, immediately after, and 4 hours after echinoid administration over two consecutive days.
Main Results:
- Significant but transient changes in mean arterial pressure and diastolic blood pressure were observed immediately post-administration.
- No significant alterations in basic hemodynamic or TPTD-derived cardiac function parameters were detected.
- Vasopressor doses in patients requiring norepinephrine therapy remained statistically unchanged.
Conclusions:
- Echinocandin administration is safe in severely critically ill patients when guidelines are followed.
- Clinicians should be aware of potential adverse effects and maintain vigilance with cardiac monitoring.
- Advanced monitoring techniques like pulse contour cardiac output can aid in optimizing patient management.
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