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Pharmacotherapy during pediatric extracorporeal membrane oxygenation: a review
Adam S Himebauch1,2, Todd J Kilbaugh1, Athena F Zuppa1,2
1a Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine , University of Pennsylvania, The Children's Hospital of Philadelphia , Philadelphia , PA , USA.
Insights
Drug pharmacokinetics (PK) are altered in critically ill children, especially during extracorporeal membrane oxygenation (ECMO). Understanding these PK changes is crucial for safe and effective drug dosing in pediatric ECMO patients.
Area of Science:
- Pharmacology
- Critical Care Medicine
- Pediatrics
Background:
- Pediatric critical illness alters drug pharmacokinetics (PK).
- Extracorporeal membrane oxygenation (ECMO) introduces further PK changes, impacting drug disposition in critically ill children.
Purpose of the Study:
- To review PK alterations in pediatric patients undergoing ECMO.
- To discuss therapeutic implications of these PK changes.
- To identify future research directions for pediatric ECMO pharmacologic investigations.
Main Methods:
- Literature review of PK studies in pediatric ECMO.
- Discussion of drug classes commonly used in pediatric ECMO (sedatives, analgesics, antimicrobials, cardiovascular drugs).
- Exploration of challenges and strategies for PK-PD studies in pediatric ECMO.
Main Results:
- Significant PK alterations occur during ECMO, affecting drug efficacy and safety.
- Limited data exists for optimal drug dosing in pediatric ECMO populations.
- PK-PD modeling and understanding ECMO physiology are key to improving dosing.
Conclusions:
- Clinicians need to understand PK alterations in pediatric ECMO for effective drug therapy.
- Further research and PK-PD modeling are essential for individualized dosing strategies.
- Addressing challenges in pediatric ECMO PK-PD studies will improve patient outcomes.
Introduction:
Pediatric critical illness and associated alterations in organ function can change drug pharmacokinetics (PK). Extracorporeal membrane oxygenation (ECMO), a life-saving therapy for severe cardiac and/or respiratory failure, causes additional PK alterations that affect drug disposition.
Areas Covered:
The purposes of this review are to discuss the PK changes that occur during ECMO, the associated therapeutic implications, and to review PK literature relevant to pediatric ECMO. We discuss various classes of drugs commonly used for pediatric patients on ECMO, including sedatives, analgesics, antimicrobials and cardiovascular drugs. Finally, we discuss future areas of research and recommend strategies for future pediatric ECMO pharmacologic investigations.
Expert Opinion:
Clinicians caring for pediatric patients treated with ECMO must have an understanding of PK alterations that could lead to either therapeutic failures or increased drug toxicity during this life-saving therapy. Limited data currently exist for optimal drug dosing in pediatric populations who are treated with ECMO. While there are clear challenges to conducting and analyzing data associated with clinical pharmacokinetic-pharmacodynamic studies of children on ECMO, we present techniques to address these challenges. Improved understanding of the physiology and drug disposition during ECMO combined with PK-PD modeling will allow for more adaptable and individualized dosing schemes.
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