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Klinische Pharmakokinetik der Antiinfektiva bei extrakorporaler Membranoxygenierung

Clinical pharmacokinetics of anti-infective drugs in extracorporeal membrane oxygenation

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Zusammenfassung

Die extrakorporale Membranoxygenierung (ECMO) gewinnt mehr und mehr an klinischer Bedeutung. Der extrakorporale Kreislauf zur Membranoxygenierung besteht aus einer Pumpe, einem extrakorporalen Membranoxygenator sowie großvolumigen Gefäßkanülen. Durch das „ECMO device“ entsteht ein zusätzliches Kompartiment, das Arzneistoffe mit hoher Lipophilie und Proteinbindung absorbieren kann. Dadurch kommt es einerseits zur Erhöhung des Verteilungsvolumens und andererseits zur Veränderung der Clearance. Als Folge können die pharmakokinetisch-pharmakodynamischen (pk-pd‑)Zielparameter nicht erreicht werden. Insofern können die Auswahl des Wirkstoffs und die Applikation – kombiniert mit therapeutischem Drugmonitoring (TDM) – wesentlich dazu beitragen, bei das therapeutische Outcome kritisch Kranken unter ECMO entscheidend zu verbessern.

Abstract

Extracorporeal membrane oxygenation (ECMO) is becoming more and more clinically important. The extracorporeal circuit for membrane oxygenation consists of a pump, a membrane oxygenator and large volume tubing. The ECMO device forms an additional compartment, which can absorb drugs with high lipophilia and protein binding. Thus, ECMO affects the volume of distribution and the clearance. As a consequence, the pharmacokinetic-pharmacodynamic (pk-pd) target parameters cannot be achieved. The selection of an appropriate substance and the mode of application, combined with therapeutic drug monitoring (TDM), can significantly improve the therapeutic outcome of critically ill patients.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie, Ludwigsburg-Bietigheim, Deutschland

    M. Bürle, M. Hoffmann & G. Geldner

  2. Zentralinstitut für Infektionsprävention und Hygienemanagement, Osnabrück, Deutschland

    S. Gfrörer

  3. Zentralapotheke des Klinikum, Ludwigsburg-Bietigheim gGmbH, Hermann-Hagenmeyerstr. 1, 71636, Ludwigsburg, Deutschland

    A. Reimer MHBA, H. Vogl & S. Schmid

Authors
  1. A. Reimer MHBA
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  2. H. Vogl
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  3. S. Schmid
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  4. S. Gfrörer
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  5. M. Bürle
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  6. M. Hoffmann
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  7. G. Geldner
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Correspondence to A. Reimer MHBA.

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Interessenkonflikt

A. Reimer, H. Vogl, S. Schmid, S. Gfrörer, M. Bürle, M. Hoffmann und G. Geldner geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Reimer, A., Vogl, H., Schmid, S. et al. Klinische Pharmakokinetik der Antiinfektiva bei extrakorporaler Membranoxygenierung. Anaesthesist 68, 821–826 (2019). https://doi.org/10.1007/s00101-019-00702-8

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