Extracorporeal Membrane Oxygenation and Drug Clearance
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The prolonged use of extracorporeal membrane oxygenation (ECMO) in the pediatric, and particularly neonatal, population to support patients for days to weeks has become increasingly commonplace over the past two decades. Along with little advancement in the underlying technology, there has been a relative paucity of research into the effects of ECMO on drug metabolism and elimination in children. By its very nature, ECMO is used in the most critically ill children, those who are often already receiving maximal pharmacological support with multiple vasoactive agents to improve their circulation. High doses of sedatives and muscle relaxants are common adjuncts to the management of the child on ECMO. The increased risk of infection requires the use of prophylactic or therapeutic antibiotics, and diuretics are frequently used to maintain fluid balance. Unlike most patients in the intensive care unit (ICU) setting, the successful use of ECMO generally requires full anticoagulation with heparin. This chapter reviews the general ways in which ECMO may affect drug clearance, and summarizes specific information regarding selected drugs that are used frequently in clinical practice.
KeywordsPulsatile Flow Extracorporeal Membrane Oxygenation ECMO Support Neonatal Abstinence Syndrome Drug Loss
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