Therapeutic drug monitoring of vancomycin in a patient on extracorporeal membrane oxygenation therapy in intensive care unit
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To the editor,
Critically ill patients exhibit extreme alterations in drug pharmacokinetics (PK) due to several pathophysiological changes. These variations may alter PK parameters as apparent volume of distribution (Vd), total clearance (Cl), and protein binding, complicating achieving adequate drug concentrations . Extracorporeal membrane oxygenation (ECMO) increases the physiological derangements, leading to deeper PK changes and more variability. Data available is limited, but suggests that ECMO can alter PK by increasing the Vd, modifying drug elimination, and drug sequestration in the ECMO circuit. In addition, ECMO therapy may be accompanied by a systemic inflammatory response syndrome (SIRS) and hemodilution [2, 3]. Therapeutic drug monitoring (TDM) and dose individualization is recommended to prevent sub-optimal drug exposure and minimize the risk of side effects. We describe the PK characteristics, TDM result, and dose individualization in a young adult man with clinical...
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Conflict of interest
The authors declare that they have no conflict of interest.