Antimicrobial therapy during ECMO - customised dosing with therapeutic drug monitoring: The way to go?
Antimicrobial therapy during ECMO - customised dosing with therapeutic drug monitoring: The way to go?
Abdul-Aziz MH, Shekar K, Roberts JA. Anaesth Crit Care Pain Med. 2019 Oct;38(5):451-453
There is a significant body of work that has emerged in last 5 years to guide antimicrobial dosing on ECMO. The article discusses whether antimicrobial dosing, based on principles of drug dosing during critical illness, along with therapeutic drug monitoring will suffice during ECMO.
Low flow rate alters haemostatic parameters in an ex-vivo extracorporeal membrane oxygenation circuit
Low flow rate alters haemostatic parameters in an ex-vivo extracorporeal membrane oxygenation circuit
Ki KK, Passmore MR, Chan CHH, Malfertheiner MV, Fanning JP, Bouquet M, Millar JE, Fraser JF, Suen JY. Intensive Care Med Exp. 2019 Aug 20;7(1):51.
The use of Extracorporeal membrane oxygenation (ECMO) is on the rise, however there are still significant complications including bleeding and thrombosis. In the following study led by Post Doc Katrina Ki, the CCRG team has shown that high vs low flow rates in ECMO differentially alter a number of haemostatic parameters.
Should Patients With Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation Have Ventilatory Support Reduced to the Lowest Tolerable Settings? No
Should Patients With Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation Have Ventilatory Support Reduced to the Lowest Tolerable Settings? No
Shekar K, Brodie D. Crit Care Med. 2019 Aug;47(8):1147-1149.
ECMO support enables clinicians to rest the diseased native lungs while they heal and recover. However optimal mechanical ventilation strategy on ECMO is not tested in clinical studies. While protecting lungs from iatrogenic harm during mechanical ventilation is important, this article argues that excessive lung testing may actually be detrimental to the patient.
ECMO for immunosuppressed patients with acute respiratory distress syndrome: drawing a line in the sand
ECMO for immunosuppressed patients with acute respiratory distress syndrome: drawing a line in the sand
Schmidt M, Combes A, Shekar K. Intensive Care Med. 2019 Aug;45(8):1140-1142.
Patient selection is key for the success of ECMO therapy. There is a growing population of immunosuppressed patients globally. Respiratory failure is a leading cause of death in these patients and this article explores the risk:benefits of applying ECMO in the immunosuppressed
Hurdles to Cardioprotection in the Critically Ill.
Hurdles to Cardioprotection in the Critically Ill.
See Hoe LE, Bartnikowski N, Wells MA, Suen JY, Fraser JF. Int J Mol Sci. 2019 Aug 5;20(15).
While some treatment options for cardiovascular disease are beneficial and essential for patient survival and restoration of cardiac function, their use comes at a physiological cost that can worsen both short- and long-term outcomes. The target cohort of critically ill cardiac patients would significantly benefit from complimentary and effective cardioprotective strategies. However, in the context of relevant surgical interventions (eg. MCS and HTx), important factors inherent to these treatments must be carefully considered to achieve clinical efficacy.
