Peng Danyang, Zhang Fan, Lv Pin, Chen Yinyin, Yang Jianxu, Zhu Wenliang, Zhu Shichao, Shao Huanzhang
Department of Critical Care Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
Henan Key Laboratory for Critical Care Medicine, Zhengzhou, China.
Ann Transl Med. 2022 May;10(10):614. doi: 10.21037/atm-22-2081.
Polymyxins antibiotics have become the first-line clinical drugs in the treatment of refractory gram-negative bacterial infections. Currently, there is a lack of clinical studies on the effect of extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy (CRRT) on polymyxin concentrations. The purpose of this report was to investigate the changes in the plasma concentrations of Colistin sulfate during ECMO and CRRT and to provide drug administration programs for critically ill patients receiving ECMO and CRRT.
In this case report, a patient with septic shock caused by severe acute pancreatitis, with abdominal pain and dyspnea as the main manifestations, was treated with ECMO combined with CRRT for life support and multiple anti-infective drugs. However, the symptoms of infection had not got improved, the inflammatory indicators remain high and the body temperature fluctuates repeatedly 36.7-38.5 ℃, was considered as carbapenem-resistant organisms (CROs) infection, and was empirically given Colistin sulfate for anti-infection treatment. Finally, the patient's condition improved and ECMO and CRRT were gradually withdrawn. At the same time, the plasma concentrations of Colistin sulfate before and after ECMO combined with CRRT, was monitored to determine the changes in the plasma concentrations of Colistin sulfate during ECMO and CRRT. Trough and peak concentrations on the 4th day of venovenous ECMO (VV-ECMO) combined with CRRT were 0.36 and 0.98 mg/L, respectively. After withdrawal of ECMO and CRRT, the concentrations were, respectively, 0.27 and 0.34 mg/L for trough concentrations, and 0.82 and 0.98 mg/L for peak concentrations. The data showed that there were no significant differences in the trough and peak concentrations of Colistin sulfate before and after ECMO and CRRT. No adverse effects occurred during follow-up.
There were no significant differences in the trough and peak concentrations of Colistin sulfate before and after ECMO and CRRT. Therefore, no dose modification is required for Colistin sulfate in patients receiving ECMO with CRRT.
多粘菌素类抗生素已成为治疗难治性革兰氏阴性菌感染的一线临床药物。目前，关于体外膜肺氧合（ECMO）联合持续肾脏替代疗法（CRRT）对多粘菌素浓度影响的临床研究较少。本报告旨在研究在ECMO和CRRT期间硫酸多粘菌素血浆浓度的变化，并为接受ECMO和CRRT的重症患者提供给药方案。
在本病例报告中，一名因严重急性胰腺炎导致感染性休克的患者，以腹痛和呼吸困难为主要表现，接受了ECMO联合CRRT进行生命支持及多种抗感染药物治疗。然而，感染症状未改善，炎症指标仍高，体温在36.7 - 38.5℃反复波动，被认为是耐碳青霉烯类菌（CROs）感染，经验性给予硫酸多粘菌素进行抗感染治疗。最终，患者病情好转，ECMO和CRRT逐渐撤机。同时，监测了ECMO联合CRRT前后硫酸多粘菌素的血浆浓度，以确定ECMO和CRRT期间硫酸多粘菌素血浆浓度的变化。在静脉 - 静脉ECMO（VV - ECMO）联合CRRT第4天的谷浓度和峰浓度分别为0.36和0.98mg/L。撤机后，谷浓度分别为0.27和0.34mg/L，峰浓度分别为0.82和0.98mg/L。数据显示，ECMO和CRRT前后硫酸多粘菌素的谷浓度和峰浓度无显著差异。随访期间未发生不良反应。
ECMO和CRRT前后硫酸多粘菌素的谷浓度和峰浓度无显著差异。因此，接受ECMO联合CRRT的患者无需调整硫酸多粘菌素的剂量。
