Opioid withdrawal in neonates after continuous infusions of morphine or fentanyl during extracorporeal membrane oxygenation

1998 ◽  
Vol 7 (5) ◽  
pp. 364-369 ◽  
Author(s):  
LS Franck ◽  
J Vilardi ◽  
D Durand ◽  
R Powers
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Continuous Infusion ◽  
Opioid Withdrawal ◽  
Opioid Analgesia ◽  
Lower Prevalence ◽  
Membrane Oxygenation ◽  
Prospective Group

BACKGROUND: Complications of opioid analgesia include tolerance and withdrawal. OBJECTIVES: To determine the effects of morphine and fentanyl on the prevalence of withdrawal after extracorporeal membrane oxygenation. METHODS: Two groups of neonates were compared during and after extracorporeal membrane oxygenation: a prospective group receiving a continuous infusion of morphine for analgesia and sedation and a retrospective group who had received a continuous infusion of fentanyl. RESULTS: Neonates receiving morphine required significantly less supplemental analgesia (P < .001) than did neonates who had received fentanyl and had a significantly lower prevalence of withdrawal after the therapy (P = .01). Neonates receiving morphine were discharged from the hospital a mean of 9.6 days sooner (P = .01) than neonates who had received fentanyl. CONCLUSIONS: Morphine may offer marked advantages over fentanyl for providing continuous analgesia and sedation in neonates.

scholarly journals Population Pharmacokinetics of Meropenem in Plasma and Subcutis from Patients on Extracorporeal Membrane Oxygenation Treatment

2018 ◽  
Vol 62 (5) ◽  
Author(s):  
Pelle Hanberg ◽  
Kristina Öbrink-Hansen ◽  
Anders Thorsted ◽  
Mats Bue ◽  
Mikkel Tøttrup ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Continuous Infusion ◽  
Prospective Observational Study ◽  
Plasma Concentrations ◽  
Content Type ◽  
Membrane Oxygenation ◽  
Population Pk ◽  
Dosing Regimens ◽  
Subcutaneous Adipose ◽  
Ecmo Treatment

ABSTRACTThe objectives of this study were to describe meropenem pharmacokinetics (PK) in plasma and/or subcutaneous adipose tissue (SCT) in critically ill patients receiving extracorporeal membrane oxygenation (ECMO) treatment and to develop a population PK model to simulate alternative dosing regimens and modes of administration. We conducted a prospective observational study. Ten patients on ECMO treatment received meropenem (1 or 2 g) intravenously over 5 min every 8 h. Serial SCT concentrations were determined using microdialysis and compared with plasma concentrations. A population PK model of SCT and plasma data was developed using NONMEM. Time above clinical breakpoint MIC forPseudomonas aeruginosa(8 mg/liter) was predicted for each patient. The following targets were evaluated: time for which the free (unbound) concentration is maintained above the MIC of at least 40% (40%fT>MIC), 100%fT>MIC, and 100%fT>4×MIC. For all dosing regimens simulated in both plasma and SCT, 40%fT>MIC was attained. However, prolonged meropenem infusion would be needed for 100%fT>MIC and 100%fT>4×MIC to be obtained. Meropenem plasma and SCT concentrations were associated with estimated creatinine clearance (eCLCr). Simulations showed that in patients with increased eCLCr, dose increment or continuous infusion may be needed to obtain therapeutic meropenem concentrations. In conclusion, our results show that using traditional targets of 40%fT>MIC for standard meropenem dosing of 1 g intravenously every 8 h is likely to provide sufficient meropenem concentration to treat the problematic pathogenP. aeruginosafor patients receiving ECMO treatment. However, for patients with an increased eCLCr, or if more aggressive targets, like 100%fT>MIC or 100%fT>4×MIC, are adopted, incremental dosing or continuous infusion may be needed.

scholarly journals Continuous infusion chemotherapy, radiotherapy, and FDG‐PET are feasible during extracorporeal membrane oxygenation

2020 ◽  
Vol 67 (9) ◽  
Author(s):  
Seth J. Rotz ◽  
Francisco A. Almeida ◽  
Shlomo Koyfman ◽  
Sudhir Krishnan ◽  
Guramrinder Singh Thind ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Continuous Infusion ◽  
Fdg Pet ◽  
Infusion Chemotherapy ◽  
Membrane Oxygenation ◽  
Continuous Infusion Chemotherapy

Morphine pharmacokinetics during continuous infusion of morphine sulfate for infants receiving extracorporeal membrane oxygenation

1997 ◽  
Vol 25 (2) ◽  
pp. 360-364 ◽  
Author(s):  
Jeremy M. Geiduschek ◽  
Anne M. Lynn ◽  
Susan L. Bratton ◽  
John C. Sanders ◽  
Fiona H. Levy ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Continuous Infusion ◽  
Morphine Sulfate ◽  
Membrane Oxygenation

Antithrombin III infusion improves anticoagulation in congenital diaphragmatic hernia patients on extracorporeal membrane oxygenation

Perfusion ◽  
2021 ◽  
pp. 026765912110638
Author(s):  
Tanya Perry ◽  
Brandon Henry ◽  
David S Cooper ◽  
Sundeep G Keswani ◽  
Kimberly S Burton ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Congenital Diaphragmatic Hernia ◽  
Continuous Infusion ◽  
Diaphragmatic Hernia ◽  
Antithrombin Iii ◽  
Factor Xa ◽  
Heparin Infusion ◽  
Membrane Oxygenation ◽  
At Iii ◽  
Life Threatening

Purpose Achieving effective anticoagulation during neonatal extracorporeal membrane oxygenation (ECMO) without increasing the risk of hemorrhage remains challenging. The use of antithrombin III (AT-III) for this purpose has been examined, but studies have been limited to intermittent bolus dosing. We aimed to evaluate the efficacy and safety of an institutionally developed AT-III continuous infusion protocol in neonates receiving ECMO for the treatment of congenital diaphragmatic hernia (CDH). Methods In this single center, retrospective study, all neonates with a CDH who received ECMO support during the study period were included. Data on anticoagulation labs and therapy, life-threatening bleeding, and circuit changes were analyzed. Results Eleven patients were divided into two groups: patients with AT-III continuous infusion ( n = 5) and without ( n = 6). There were no differences in the gestational age ( p = 0.29), sex ( p = 1.00), ECMO duration ( p = 0.59), or initial AT-III levels ( p = 0.76) between groups. Patients in the AT-III infusion group had on average 18.5% higher AT-III levels ( p < 0.0001). Patients receiving continuous AT-III infusions spent a significantly higher percentage of ECMO time within the therapeutic range, measured using anti-Factor Xa levels (64.9±4.2% vs. 29.1±8.57%, p = 0.008), and required fewer changes to the heparin infusion rate (6.48±0.88 vs 2.38±0.36 changes/day changes/day, p = 0.005). Multivariate analysis revealed continuous infusion of AT-III did not increase the rate of intracranial or surgical bleeding ( p = 0.27). Conclusion AT-III as a continuous infusion in CDH neonates on ECMO provides a decreased need to modify heparin infusion and more consistent therapeutic anticoagulation without increasing the risk of life-threatening bleeding.

Selective heparinization of the extracorporeal membrane oxygenation circuit using continuous infusions of protamine and heparin in a short-term pig model

Perfusion ◽  
1994 ◽  
Vol 9 (5) ◽  
pp. 327-333 ◽  
Author(s):  
Lorraine A Dickey ◽  
T Jeffrey Butler ◽  
Thomas M Bergmann ◽  
Melanie E Bates ◽  
Donald M Null
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Continuous Infusion ◽  
Venous Catheter ◽  
Haemodynamic Instability ◽  
Extracorporeal Circuit ◽  
Short Term ◽  
Ecmo Circuit ◽  
Membrane Oxygenation ◽  
Systemic Heparinization ◽  
Patient At Risk

Systemic heparinization is required for both neonatal and paediatric extracorporeal membrane oxygenation (ECMO). However, it places the patient at risk of serious haemorrhage. We report an alternative: 'selective' heparinization of the ECMO circuit using a continuous infusion of heparin near the venous catheter as blood enters the circuit, and a simultaneous protamine infusion near the arterial catheter as blood enters the patient. Theoretically, the circuit remains heparinized while the patient maintains near-normal clotting activity. Three healthy piglets were placed on venoarterial ECMO in standard fashion. When the animal and its extracorporeal circuit flow were stable, a protamine infusion was begun: 1 mg of protamine to neutralize each 100 units of infused heparin. No haemodynamic instability was noted during the five hours of each study. Mean activated clotting times (ACT) were significantly lower in all three piglets than in their respective circuits ( p < 0.001). We conclude that 'selective' heparinization of the ECMO circuit is possible using continuous infusions of protamine and heparin in a short-term piglet model.

scholarly journals Continuous Antithrombin III Administration in Pediatric Veno-Arterial Extracorporeal Membrane Oxygenation

2017 ◽  
Vol 22 (4) ◽  
pp. 266-271 ◽  
Author(s):  
Kristina M. Nelson ◽  
Lizbeth A. Hansen ◽  
Marie E. Steiner ◽  
Gwenyth A. Fischer ◽  
John Dehnel ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Continuous Infusion ◽  
Antithrombin Iii ◽  
Pediatric Intensive Care ◽  
Heparin Dose ◽  
Retrospective Case ◽  
Product Usage ◽  
Membrane Oxygenation ◽  
Lower Blood ◽  
Infusion Protocol

The purpose of this retrospective case-control study is to determine the effect of continuous antithrombin III (ATIII) infusion on extracorporeal membrane oxygenation (ECMO) coagulation. All ECMO patients within the pediatric intensive care unit from January 2012 to July 2014 were included. Comparison was made between those who received continuous infusion ATIII through a standardized replacement protocol with historic controls receiving intermittent ATIII doses. Patients receiving the continuous infusion ATIII protocol spent more time in goal ACT range (71.9% vs 52.2%, p &lt; 0.0001). Mean daily ATIII activity was also increased in study group (77.3% versus 68.6%, p = 0.04). No statistical differences in number of heparin dose changes per day (3 versus 3.22, p = 0.90) were present between the 2 groups. Only 28% of the historic controls receiving intermittent ATIII doses achieved normal ATIII activity as compared with 80% of study patients (p = 0.24). Maximum heparin dose was also lower in continuous infusion protocol group (p &lt; 0.01). Compared with nonprotocolized intermittent dosing, the use of a continuous infusion ATIII protocol demonstrated increased time within goal ACT range at a lower heparin dose, no increase in hemostatic complications, and trends toward fewer heparin changes and lower blood product usage.

scholarly journals Continuous-Infusion Etomidate in a Patient Receiving Extracorporeal Membrane Oxygenation

2017 ◽  
Vol 22 (1) ◽  
pp. 65-68
Author(s):  
Joseph M. LaRochelle ◽  
Bonnie Desselle ◽  
Janet L. Rossi
Keyword(s):  
Blood Pressure ◽  
Metabolic Acidosis ◽  
Extracorporeal Membrane Oxygenation ◽  
Continuous Infusion ◽  
High Dose ◽  
Membrane Oxygenation ◽  
Blood Pressures ◽  
Alternative Medications ◽  
Osmolar Gap

We describe a 16-year-old, 65-kg male deployed on extracorporeal membrane oxygenation (ECMO) for refractory respiratory failure secondary to ingestion of multiple substances. During his ECMO course, standard sedative and analgesic strategies failed and alternative medications were used. The patient received various dosages of fentanyl, morphine, hydromorphone, clonidine patches, dexmedetomidine, lorazepam, methadone, pentobarbital, olanzapine, and propofol. Despite administration of multiple agents, on day 29 of ECMO the patient experienced elevated blood pressures due to agitation, and continuous infusion etomidate was started. At the time of etomidate initiation, the osmolar gap was 8 mOsm/kg. During etomidate therapy, the blood pressure remained normal, sedative agents were slowly weaned, and the patient required few PRN medications. On day 6 of etomidate, the osmolar gap increased to 127 mOsm/kg and etomidate was discontinued. Continuous-infusion ketamine was started, but the blood pressure was not controlled. Metabolic acidosis is a known side effect of etomidate due to inclusion of propylene glycol as a pharmaceutical solvent in the formulation. Despite high-dose etomidate (20 mcg/kg/min) for approximately 6 days, our patient did not experience metabolic acidosis. Absence of this adverse effect caused us to question the role of the ECMO circuit. To our knowledge, this is the first report of the use of continuous-infusion etomidate during ECMO. Etomidate infusion could be considered in difficult-to-manage patients after other alternatives have failed.

Extracorporeal membrane oxygenation support after heart- or lungtransplantation

2011 ◽  
Vol 59 (S 01) ◽  
Author(s):  
A Mühle ◽  
G Färber ◽  
T Doenst ◽  
M Barten ◽  
J Garbade ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation
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