Related Experiment Video

Updated: Dec 26, 2025

Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
04:55

Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model

Published on: May 26, 2023

1.2K

Patterns of Medication Exposure in Children on Extracorporeal Membrane Oxygenation: A Step in Prioritizing Future

Céline Thibault1,2, Hailey Collier3, Maryam Y Naim1

  • 1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.

Critical Care Explorations
|March 14, 2020
PubMed

Insights

Critically ill children on extracorporeal membrane oxygenation receive numerous medications, with limited pharmacokinetic and pharmacodynamic data available to guide dosing. Future research is needed to establish evidence-based dosing guidelines for these vulnerable patients.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Extracorporeal Membrane Oxygenation

Background:

  • Extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill pediatric patients.
  • Patients on ECMO often receive a high number of medications, necessitating an understanding of their drug disposition and effects.
  • Limited pharmacokinetic and pharmacodynamic (PK/PD) data exist for many drugs used in this population.

Purpose of the Study:

  • To identify all medications administered to pediatric patients undergoing ECMO.
  • To review existing PK/PD literature for the most frequently used medications during ECMO.
  • To highlight gaps in knowledge and inform future research directions.

Main Methods:

  • A retrospective, single-center study was conducted at the Children's Hospital of Philadelphia.
  • Data were collected for pediatric patients supported by ECMO between October 2014 and September 2018.
  • Medication administration records and existing PK/PD literature were analyzed.

Main Results:

  • A total of 179 different medications were administered to 254 pediatric patients on ECMO.
  • Drug exposure increased with ECMO duration, with a median of 31 drugs by 5 weeks.
  • Published PK/PD literature supported the use of only 40% of the most common medications, with dosing guidance available for just 20%, primarily for neonates and infants.

Conclusions:

  • There is a significant lack of PK/PD data and established dosing guidelines for medications used in pediatric ECMO patients.
  • Optimizing the care of critically ill children on ECMO requires targeted PK/PD studies.
  • Evidence-based dosing guidelines are crucial for improving patient outcomes.

Keywords:
critical caredrug utilizationextracorporeal life supportpediatricspharmacokineticsreview literature

More Related Videos

Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse06:41

Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse

Published on: October 24, 2018

12.9K
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting03:40

Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting

Published on: January 17, 2025

685

Related Concept Videos

Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
156
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
143
Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
198
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
182
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
185
Therapeutic Drug Monitoring: Affecting Factors01:29

Therapeutic Drug Monitoring: Affecting Factors

Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
135