Cargando…
Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood
INTRODUCTION: As a result of drug sequestration and increased volume of distribution, the extracorporeal membrane oxygenation (ECMO) procedure might lead to a decrease in drug concentrations during a patient’s treatment. The aim of this study was to evaluate sedative, antibiotic and immunosuppressiv...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4335544/ https://www.ncbi.nlm.nih.gov/pubmed/25886890 http://dx.doi.org/10.1186/s13054-015-0772-5 |
_version_ | 1782358359709581312 |
---|---|
author | Lemaitre, Florian Hasni, Nesrine Leprince, Pascal Corvol, Emmanuel Belhabib, Ghassen Fillâtre, Pierre Luyt, Charles-Edouard Leven, Cyril Farinotti, Robert Fernandez, Christine Combes, Alain |
author_facet | Lemaitre, Florian Hasni, Nesrine Leprince, Pascal Corvol, Emmanuel Belhabib, Ghassen Fillâtre, Pierre Luyt, Charles-Edouard Leven, Cyril Farinotti, Robert Fernandez, Christine Combes, Alain |
author_sort | Lemaitre, Florian |
collection | PubMed |
description | INTRODUCTION: As a result of drug sequestration and increased volume of distribution, the extracorporeal membrane oxygenation (ECMO) procedure might lead to a decrease in drug concentrations during a patient’s treatment. The aim of this study was to evaluate sedative, antibiotic and immunosuppressive drug loss in ECMO circuit using ex-vivo and in-vitro experiments. METHODS: Blood concentrations of propofol, midazolam, cyclosporine and vancomycin were measured in an ex-vivo ECMO circuit primed with whole human blood, and compared to controls stored in polypropylene tubes. In vitro experiments were also conducted to further explore the role of temperature, oxygen exposure and polyvinylchloride surfaces on propofol loss in the ECMO circuit. RESULTS: Propofol concentration decreased rapidly; 70% of its baseline concentration was lost after only 30 minutes, and only 11% remained after five hours (P <0.001 for the comparison with control polypropylene tube propofol concentration). Further experiments demonstrated that oxygen exposure and contact with polyvinylchloride tubing were respectively responsible for 70% and 85% of propofol loss after 45 minutes. Midazolam concentration also rapidly decreased in the ECMO circuit, with only 54% and 11% of baseline concentration being detected at 30 minutes and 24 hours respectively (P = 0.01 versus control). Alternatively, cyclosporine concentration remained stable for the five first hours, then decreased to 78% and 73% of the baseline value after 24 hours and 48 hours, (P = 0.35 versus control). Lastly, vancomycin concentration remained stable in the ECMO circuit for the 48-hour experimental protocol. CONCLUSIONS: We observed important losses of propofol and midazolam, while cyclosporine concentration decreased slowly and moderately, and vancomycin concentration remained unchanged in the ex-vivo ECMO circuit primed with whole human blood. These data might help intensive care unit physicians planning clinical trials with a final objective to better adapt doses of these drugs while treating critically ill ECMO patients. |
format | Online Article Text |
id | pubmed-4335544 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-43355442015-02-21 Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood Lemaitre, Florian Hasni, Nesrine Leprince, Pascal Corvol, Emmanuel Belhabib, Ghassen Fillâtre, Pierre Luyt, Charles-Edouard Leven, Cyril Farinotti, Robert Fernandez, Christine Combes, Alain Crit Care Research INTRODUCTION: As a result of drug sequestration and increased volume of distribution, the extracorporeal membrane oxygenation (ECMO) procedure might lead to a decrease in drug concentrations during a patient’s treatment. The aim of this study was to evaluate sedative, antibiotic and immunosuppressive drug loss in ECMO circuit using ex-vivo and in-vitro experiments. METHODS: Blood concentrations of propofol, midazolam, cyclosporine and vancomycin were measured in an ex-vivo ECMO circuit primed with whole human blood, and compared to controls stored in polypropylene tubes. In vitro experiments were also conducted to further explore the role of temperature, oxygen exposure and polyvinylchloride surfaces on propofol loss in the ECMO circuit. RESULTS: Propofol concentration decreased rapidly; 70% of its baseline concentration was lost after only 30 minutes, and only 11% remained after five hours (P <0.001 for the comparison with control polypropylene tube propofol concentration). Further experiments demonstrated that oxygen exposure and contact with polyvinylchloride tubing were respectively responsible for 70% and 85% of propofol loss after 45 minutes. Midazolam concentration also rapidly decreased in the ECMO circuit, with only 54% and 11% of baseline concentration being detected at 30 minutes and 24 hours respectively (P = 0.01 versus control). Alternatively, cyclosporine concentration remained stable for the five first hours, then decreased to 78% and 73% of the baseline value after 24 hours and 48 hours, (P = 0.35 versus control). Lastly, vancomycin concentration remained stable in the ECMO circuit for the 48-hour experimental protocol. CONCLUSIONS: We observed important losses of propofol and midazolam, while cyclosporine concentration decreased slowly and moderately, and vancomycin concentration remained unchanged in the ex-vivo ECMO circuit primed with whole human blood. These data might help intensive care unit physicians planning clinical trials with a final objective to better adapt doses of these drugs while treating critically ill ECMO patients. BioMed Central 2015-02-12 2015 /pmc/articles/PMC4335544/ /pubmed/25886890 http://dx.doi.org/10.1186/s13054-015-0772-5 Text en © Lemaitre et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Lemaitre, Florian Hasni, Nesrine Leprince, Pascal Corvol, Emmanuel Belhabib, Ghassen Fillâtre, Pierre Luyt, Charles-Edouard Leven, Cyril Farinotti, Robert Fernandez, Christine Combes, Alain Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood |
title | Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood |
title_full | Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood |
title_fullStr | Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood |
title_full_unstemmed | Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood |
title_short | Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood |
title_sort | propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4335544/ https://www.ncbi.nlm.nih.gov/pubmed/25886890 http://dx.doi.org/10.1186/s13054-015-0772-5 |
work_keys_str_mv | AT lemaitreflorian propofolmidazolamvancomycinandcyclosporinetherapeuticdrugmonitoringinextracorporealmembraneoxygenationcircuitsprimedwithwholehumanblood AT hasninesrine propofolmidazolamvancomycinandcyclosporinetherapeuticdrugmonitoringinextracorporealmembraneoxygenationcircuitsprimedwithwholehumanblood AT leprincepascal propofolmidazolamvancomycinandcyclosporinetherapeuticdrugmonitoringinextracorporealmembraneoxygenationcircuitsprimedwithwholehumanblood AT corvolemmanuel propofolmidazolamvancomycinandcyclosporinetherapeuticdrugmonitoringinextracorporealmembraneoxygenationcircuitsprimedwithwholehumanblood AT belhabibghassen propofolmidazolamvancomycinandcyclosporinetherapeuticdrugmonitoringinextracorporealmembraneoxygenationcircuitsprimedwithwholehumanblood AT fillatrepierre propofolmidazolamvancomycinandcyclosporinetherapeuticdrugmonitoringinextracorporealmembraneoxygenationcircuitsprimedwithwholehumanblood AT luytcharlesedouard propofolmidazolamvancomycinandcyclosporinetherapeuticdrugmonitoringinextracorporealmembraneoxygenationcircuitsprimedwithwholehumanblood AT levencyril propofolmidazolamvancomycinandcyclosporinetherapeuticdrugmonitoringinextracorporealmembraneoxygenationcircuitsprimedwithwholehumanblood AT farinottirobert propofolmidazolamvancomycinandcyclosporinetherapeuticdrugmonitoringinextracorporealmembraneoxygenationcircuitsprimedwithwholehumanblood AT fernandezchristine propofolmidazolamvancomycinandcyclosporinetherapeuticdrugmonitoringinextracorporealmembraneoxygenationcircuitsprimedwithwholehumanblood AT combesalain propofolmidazolamvancomycinandcyclosporinetherapeuticdrugmonitoringinextracorporealmembraneoxygenationcircuitsprimedwithwholehumanblood |