有或没有ECMO的机械通风COVID-19患者的抗真菌度:CAPADOSE观测回顾性多中心研究
Paul Masi1, Mickael Lescroart2, Anne Veinstein3
1AP-HP, Hôpitaux Universitaires Henri-Mondor, Créteil, France; Université Paris Est Créteil, Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomédicale-Groupe de recherche clinique CARMAS, Créteil, France; Université Paris Est Créteil, INSERM, IMRB, Créteil, France.
概括
与COVID-19相关的肺阿斯伯吉洛症 (CAPA) 患者经常经历治疗次的抗真菌药物水平. 身体外膜氧化 (ECMO) 在这些重症患者中没有显著影响伏利可纳的暴露.
科学领域:
- 关键护理医学 关键护理医学
- 传染病 传染病 传染病
- 药理学 药理学是指药理学的学科.
背景情况:
- 与COVID-19相关的肺阿斯伯吉洛症 (CAPA) 是重症患者的一种严重的共感染,与较高的死亡率有关.
- 抗真菌药物的药理动力学可能会在重症患者中发生变化,特别是那些需要体外膜氧化 (ECMO) 患者,这引发了对治疗疗效的担忧.
研究的目的:
- 调查ECMO对CAPA患者中亚治疗性伏利可纳水平风险的影响.
- 在CAPA患者中确定与非最佳抗真菌药物暴露相关的风险因素.
主要方法:
- 一个多中心的回顾性研究,涉及166名CAPA患者,在20个ICU需要机械通风.
- 收集了抗真菌药物的血液水平,重点是沃里康纳和伊萨武康纳,以评估治疗暴露.
- 分析患者数据,包括ECMO状态和替代疗法,以确定次治疗药物水平的风险因素.
主要成果:
- 超过一半的CAPA患者 (56%) 在ICU逗留期间经历了亚治疗性沃里可纳水平.
- 在ECMO和非ECMO患者之间没有观察到亚治疗性伏利康纳水平的显著差异.
- 替代疗法,而不是ECMO,被确定为亚治疗性伊萨武可纳水平的危险因素.
结论:
- 在CAPA患者中,亚治疗性抗真菌药物水平是常见的.
- 在这种患者群体中,ECMO似乎没有显著影响伏利康纳暴露.
- 识别置换疗法等危险因素对于优化CAPA重症患者的抗真菌剂量至关重要.
相关概念视频
01:28Antimicrobial Effectiveness
163
The effectiveness of antimicrobial agents depends on various factors influencing their ability to eliminate microbial populations. Larger microbial populations require more time for complete eradication, emphasizing the importance of population size analysis when evaluating antimicrobial efficacy.Microbial resistance to antimicrobial agents varies significantly. Highly resilient microorganisms include endospores, gram-negative bacteria, and non-enveloped viruses, while prions are exceptionally...
163
01:23Mechanical Ventilation III: Noninvasive Ventilation
227
Noninvasive positive-pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) are essential methods in respiratory care. These ventilation techniques offer unique benefits for patients with various respiratory conditions, providing adequate support without requiring intubation. Let's explore how each method is crucial in improving patient outcomes and enhancing respiratory therapy.
Noninvasive Positive-Pressure Ventilation...
Noninvasive Positive-Pressure Ventilation...
227
01:23Mechanical Ventilation II: Invasive Ventilation
256
Ventilators are essential medical equipment used to aid patients with respiratory difficulties. Their primary function is to assist or replace spontaneous breathing by providing mechanical ventilation. There are two general classes of mechanical ventilators: negative-pressure and positive-pressure ventilators.
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
256
01:28Pneumonia IV: Management
451
The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
451