Lahmer Tobias, Schnappauf Christopher, Messer Marlena, Rasch Sebastian, Fekecs Lisa, Beitz Analena, Eser Stefan, Schmid Roland M, Huber Wolfgang
II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
Infection. 2015 Dec;43(6):723-7. doi: 10.1007/s15010-015-0828-0. Epub 2015 Aug 11.
Fungal infections present a constant risk to critically ill and immunocompromised patients. Therefore, treatment guidelines recommend echinocandins as first-line antifungals in critically ill patients to improve patient outcomes. Echinocandins are usually well tolerated; nevertheless, rare adverse events can occur. There are reports of temporary deterioration of hemodynamic parameters during loading doses, especially in critically ill patients. The objective of this study is to analyze the hemodynamic changes during administration of the echinocandin antifungals, caspofungin and anidulafungin, in medical intensive care unit patients.
A prospective study in medical ICU patients receiving echinocandins was monitored using single-indicator transpulmonary thermodilution (TPTD). TPTD measurements were performed immediately before, directly after, and 4 h after echinocandins on two following days.
Mean arterial pressure and also diastolic blood pressure showed significant changes (p < 0.042 and p < 0.007) after echinocandin application in the measurement immediately after application, but not after 4 h. Basic hemodynamic parameters as well as the TPTD-derived cardiac function parameters did not significantly change after echinocandin application at all. In patients with the need for norepinephrine therapy, the vasopressor dose was not statistically significantly altered.
To conclude, administration of echinocandins in this observed study population is safe, even in severely critically ill patients if application rules of these agents are followed. However, adverse effects could be observed and practitioners should be cognizant of these effects. These observations can be optimized by high-level assessments, such as the pulse contour cardiac output monitoring, and clinicians should continue to be vigilant with cardiac monitoring of patients receiving echinocandin antifungals.
真菌感染对重症和免疫功能低下患者构成持续风险。因此，治疗指南推荐棘白菌素类药物作为重症患者的一线抗真菌药物，以改善患者预后。棘白菌素类药物通常耐受性良好；然而，罕见的不良事件仍可能发生。有报道称，在负荷剂量给药期间，血流动力学参数会出现暂时恶化，尤其是在重症患者中。本研究的目的是分析在医学重症监护病房患者中给予棘白菌素类抗真菌药物卡泊芬净和阿尼芬净时的血流动力学变化。
对接受棘白菌素类药物治疗的医学重症监护病房患者进行前瞻性研究，采用单指标经肺热稀释法（TPTD）进行监测。在使用棘白菌素类药物之前、用药后立即以及随后两天用药后4小时进行TPTD测量。
用药后立即测量时，应用棘白菌素类药物后平均动脉压和舒张压均出现显著变化（p < 0.042和p < 0.007），但4小时后未出现变化。应用棘白菌素类药物后，基本血流动力学参数以及TPTD衍生的心脏功能参数均未出现显著变化。对于需要去甲肾上腺素治疗的患者，血管升压药剂量在统计学上无显著改变。
总之，在本观察研究人群中，即使是严重的重症患者，只要遵循这些药物的应用规则，给予棘白菌素类药物是安全的。然而，可以观察到不良反应，从业者应认识到这些影响。通过高级评估，如脉搏轮廓心输出量监测，可以优化这些观察结果，临床医生应继续对接受棘白菌素类抗真菌药物治疗的患者进行心脏监测并保持警惕。
