Báo cáo y học: An exploratory study with an adaptive continuous intravenous furosemide regimen in neonates treated with extracorporeal membrane oxygenation

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: An exploratory study with an adaptive continuous intravenous furosemide regimen in neonates treated with extracorporeal membrane oxygenation...
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Báo cáo y học: "An exploratory study with an adaptive continuous intravenous furosemide regimen in neonates treated with extracorporeal membrane oxygenation" Available online http://ccforum.com/content/11/5/R111Research Open AccessVol 11 No 5An exploratory study with an adaptive continuous intravenousfurosemide regimen in neonates treated with extracorporealmembrane oxygenationMaria MJ van der Vorst1,2, Jan den Hartigh3, Enno Wildschut4, Dick Tibboel2 andJacobus Burggraaf11Centrefor Human Drug Research, Leiden, The Netherlands2Department of Paediatric Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands3Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands4Department of Paediatrics, Erasmus Medical Centre, Rotterdam, The NetherlandsCorresponding author: Dick Tibboel, d.tibboel@erasmusmc.nlReceived: 12 Apr 2007 Revisions requested: 13 Jun 2007 Revisions received: 24 Jul 2007 Accepted: 10 Oct 2007 Published: 10 Oct 2007Critical Care 2007, 11:R111 (doi:10.1186/cc6146)This article is online at: http://ccforum.com/content/11/5/R111© 2007 van der Vorst et al., licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractIntroduction The objective of the present study was to explore urine production of the study subjects) urine production over thea continuous intravenous furosemide regimen that adapts to consecutive study days was 6.8 (0.8–8.4) mg/kg per hour, 6.0urine output in neonates treated with extracorporeal membrane (4.7–8.9) mg/kg per hour and 5.4 (3.4–10.1) ml/kg per hour.oxygenation (ECMO). The target urine production was reached after a median time of 7 (3–37) hours. The regimen was haemodynamically wellMethods Seven neonates admitted to a paediatric surgical tolerated and the median furosemide serum concentration was 3.1 (0.4–12.9) μg/ml, well below the toxic level.intensive care unit for ECMO therapy were treated with afurosemide regimen consisting of a loading bolus (1–2 mg/kg)followed by a continuous infusion at 0.2 mg/kg per hour, whichwas adjusted according to the target urine production of 6 ml/ Conclusion The evaluated furosemide infusion appears ankg per hour. Therapeutic drug monitoring for furosemide effective means to reduce volume overload in neonates treatedconcentrations in blood was performed. with ECMO. The data of this preliminary study suggest that the starting dose of furosemide was too high, however, because theResults The mean ± standard deviation furosemide dose was urine output was excessive and required frequent adaptations.0.17 ± 0.06 mg/kg per hour, 0.08 ± 0.04 mg/kg per hour and The results of this study therefore indicate that a novel0.12 ± 0.07 mg/kg per hour, respectively, on the first day, pharmacokinetic/pharmacodynamic model needs to besecond day and third day of the study. The median (range of the developed for neonates treated with ECMO.Introduction fusion [2]. Consequently, in the initial phase (in the first 24–48Extracorporeal membrane oxygenation (ECMO) is used mainly hours) the ECMO patient becomes usually increasingly oede-in neonates to treat a variety of cardiorespiratory problems matous. Diuretics, especially loop diuretics such as furosem-such as meconium aspiration syndrome, congenital diaphrag- ide, are therefore the mainstay in the enhancement of diuresismatic hernia, persistent pulmonary hypertension of the new- to mobilize fluid excess. Furosemide is often used as a contin-born, and sepsis/pneumonia [1]. uous infusion in patients treated with ECMO, based upon the observations in infants after CPB surgery [3-6].The ECMO circuit, like the cardiopulmonary bypass (CPB) cir-cuit, triggers an important inflammatory reaction and is clini- We recently made an inventory of furosemide reg ...