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Antifungal Dosing in Critically Ill Patients on Extracorporeal Membrane Oxygenation

Haifa Lyster1,2, Kiran Shekar3,4,5,6, Kevin Watt7,8

  • 1Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK.

Clinical Pharmacokinetics
|June 10, 2023
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) requires careful antifungal dosing due to altered pharmacokinetics. Therapeutic drug monitoring is recommended for critically ill patients on ECMO to ensure effective antifungal exposure.

Area of Science:

  • Critical Care Medicine
  • Pharmacology
  • Infectious Diseases

Background:

  • Extracorporeal membrane oxygenation (ECMO) provides life support for critically ill patients.
  • Fungal infections in ECMO patients are linked to higher mortality rates.
  • Antifungal drug dosing is complex in critical illness due to altered pharmacokinetics (PK).

Purpose of the Study:

  • To review available literature on antifungal drug dosing for critically ill patients undergoing ECMO.
  • To provide guidance on managing antifungal therapy in this challenging patient population.

Main Methods:

  • Literature review of pharmacokinetic (PK) studies on antifungals in critically ill patients on ECMO.
  • Analysis of existing case reports and small-sample studies.

Main Results:

  • Current literature on antifungal PK in ECMO patients is limited, with inconsistent findings and data gaps.
  • Pharmacokinetic changes, including volume of distribution (Vd) and clearance, are exacerbated by ECMO.
  • Existing data are insufficient for definitive empirical dosing guidelines.

Conclusions:

  • Dosing strategies from critically ill patients not on ECMO may be a reasonable starting point.
  • Therapeutic drug monitoring is crucial for optimizing antifungal therapy and preventing toxicity in ECMO patients due to high PK variability.

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