Background: Extracorporeal membrane oxygenation (ECMO) is an extracorporeal circulation system that gives respiratory and/or cardiac support. Blood flow is high (3-5 litres per minute). ECMO patients suffer significant pharmacokinetic changes that require dosage adjustment. Patients underwent ECMO support have risk for acquiring invasive fungal infections. Until nowadays, no data to guide drug therapy is available for micafungin in ECMO patients. The objective was study pharmacokinetics of micafungin in 10 patients receiving ECMO support.
Material/methods: Pharmacokinetic study performed in 10 patients receiving ECMO support, treated with micafungin for prophylaxis, or a proven or suspected fungal infection. Polimethylpentene membrane oxygenation and centrifugal pump was used. Patients were recruited in the intensive care unit of two tertiary hospitals. All patients received 100 mg/day of micafungin with 1 hour of infusion rate. Micafungin drug concentrations were measured at different points of the dosing interval before (Cin) and after (Cout) the ECMO membrane and were analyzed by high-performance liquid chromatography (HPLC). Drug recovery (DR) was calculated as the ratio between the Cout and Cin of micafungin. Results: Venous-arterial ECMO was placed in all patients
The mean (SD) values of the concentration of micafungin and the DR are detailed in table 1.
Conclusions: Micafungin seems to be minimally sequestered in the ECMO circuit except in the time of the end of the 1 h infusion. Plasma concentrations of micafungin were similar or higher than those observed in critically ill patients. It suggests that in ECMO patients treated with micafungin no dose adjustment is required.
Full conference title:
- ECCMID 26th (2016)