4CPS-177 Optimisation of the therapeutic management of patients on ecmo in the paediatric intensive care unit. Issue 1 (23rd March 2023)

• Record Type: Journal Article
• Authors: Hanafia, O; Capelle, H; Leonelli, J; Honore, S; Bertault-Peres, P
• Is Part Of: European journal of hospital pharmacy. Volume 30:Issue 1(2023)supplement 1
• Page Start: A81
• Page End: A81
• Publication Date: 2023-03-23
• Subjects: Pharmacy -- Periodicals; Hospital pharmacies -- Periodicals; 615.1
• DOI: 10.1136/ejhpharm-2023-eahp.170
• Languages: English
• ISSNs: 2047-9956

Abstract

Abstract : Background and Importance: Extracorporeal Membrane Oxygenation (ECMO) is a last-resort rescue technique that allows the replacement of circulatory and/or respiratory functions. The pharmacokinetic modifications generated by this circulatory assistance require the adaptation of the dosage of certain drugs Aim and Objectives: The objective was to compare the drug prescription of patients under ECMO with data available in the literature to propose appropriate dosages Material and Methods: Our 6-month prospective observational monocentric study focuses on patients in the paediatric intensive care unit receiving ECMO. Clinico-biological data were collected from the computerised patient record and by our daily presence in the department. We noted the type and indication of ECMO, complications and adequacy of dosages compared to the literature for relevance Results: 14 patients under ECMO were included: mean age 18 months [0 to 168 months], sex ratio=1. Renal function was impaired in 8 patients (57%). The average duration of ECMO was 15 days [3-24 days]. 6 patients were weaned, 4 of whom were still hospitalised on the ward (43%) and 8 patients died (57%). 13 patients (93%) were on veno-arterial ECMO, following acute respiratory distress syndrome (8 cases or 61%), refractory cardiac arrest (3 cases 23%), cardiogenic shock (8%) or septic shock (8%). 1 patient (7%) was on veno-venous ECMO following an acute respiratory distress syndrome (ARDS). 11 patients (79%) developed complications related to ECMO (9 haemorrhages, 8 hemolysis, 6 oxygenation difficulties, 5 PAO, 4 stroke). Concerning the drug management of these patients, we counted 16 overdoses and 2 underdoses not justified either by the literature or by therapeutic drug monitioring (TDM) i.e. 18 nonconformities out of 73 lines analysed (Vancomycin, Gentamicin, Fluconazole, Caspofungin, Voriconazole, Ganciclovir, Heparin, Morphine, Sufentanil, Midazolam, Cisatracurium, Hydrocortisone Hemisuccinate, Methadone) Conclusion and Relevance: The populations studied in the literature remain different from ours, making it difficult to discuss our clinical results. However, following the non-conformities of dosage noted, we propose a table of dosage adaptation under ECMO synthesising the literature for the studied molecules which is systematically accompanied by instructions to make a TDM References and/or Acknowledgements: Conflict of Interest: No conflict of interest