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Pediatric cardiovascular drug dosing in critically ill children and extracorporeal membrane oxygenation.

Publication ,  Journal Article
Watt, K; Li, JS; Benjamin, DK; Cohen-Wolkowiez, M
Published in: J Cardiovasc Pharmacol
August 2011

Cardiovascular disease in children is common and results in significant morbidity and mortality. The sickest children with cardiovascular disease may require support with extracorporeal membrane oxygenation (ECMO), which provides life-saving assistance for children with refractory cardiorespiratory failure. Many classes of cardiovascular drugs are used in children, but very few of these agents have been well studied in children. The knowledge gap is even more pronounced in children supported by ECMO. Pharmacokinetic (PK) data collected to date (primarily from antibiotics and sedatives) suggest that the ECMO circuit has the potential to significantly alter the PK of drugs including changes in clearance and volume of distribution. Of all cardiovascular drugs administered to children supported by ECMO, only 11 have been partially studied and reported in the medical literature. Esmolol, amiodarone, nesiritide, bumetanide, sildenafil, and prostaglandin E1 seem to require dosing modifications in children supported by ECMO, whereas it seems that hydralazine, nicardipine, furosemide, epinephrine, and dopamine can be dosed similarly to children not supported by ECMO. However, trials evaluating the PK of these drugs in patients supported by ECMO are extremely limited (ie, case reports), and therefore, definitive dosing recommendations are not plausible. Research efforts should focus on evaluating the PK of drugs in patients on ECMO to avoid therapeutic failures or unnecessary toxicities.

Duke Scholars

Published In

J Cardiovasc Pharmacol

DOI

EISSN

1533-4023

Publication Date

August 2011

Volume

58

Issue

2

Start / End Page

126 / 132

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Infant, Newborn
  • Infant
  • Humans
  • Extracorporeal Membrane Oxygenation
  • Drug Therapy, Combination
  • Drug Administration Schedule
  • Diuretics
  • Critical Illness
  • Combined Modality Therapy
 

Citation

APA
Chicago
ICMJE
MLA
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Watt, K., Li, J. S., Benjamin, D. K., & Cohen-Wolkowiez, M. (2011). Pediatric cardiovascular drug dosing in critically ill children and extracorporeal membrane oxygenation. J Cardiovasc Pharmacol, 58(2), 126–132. https://doi.org/10.1097/FJC.0b013e318213aac2
Watt, Kevin, Jennifer S. Li, Daniel K. Benjamin, and Michael Cohen-Wolkowiez. “Pediatric cardiovascular drug dosing in critically ill children and extracorporeal membrane oxygenation.J Cardiovasc Pharmacol 58, no. 2 (August 2011): 126–32. https://doi.org/10.1097/FJC.0b013e318213aac2.
Watt K, Li JS, Benjamin DK, Cohen-Wolkowiez M. Pediatric cardiovascular drug dosing in critically ill children and extracorporeal membrane oxygenation. J Cardiovasc Pharmacol. 2011 Aug;58(2):126–32.
Watt, Kevin, et al. “Pediatric cardiovascular drug dosing in critically ill children and extracorporeal membrane oxygenation.J Cardiovasc Pharmacol, vol. 58, no. 2, Aug. 2011, pp. 126–32. Pubmed, doi:10.1097/FJC.0b013e318213aac2.
Watt K, Li JS, Benjamin DK, Cohen-Wolkowiez M. Pediatric cardiovascular drug dosing in critically ill children and extracorporeal membrane oxygenation. J Cardiovasc Pharmacol. 2011 Aug;58(2):126–132.

Published In

J Cardiovasc Pharmacol

DOI

EISSN

1533-4023

Publication Date

August 2011

Volume

58

Issue

2

Start / End Page

126 / 132

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Infant, Newborn
  • Infant
  • Humans
  • Extracorporeal Membrane Oxygenation
  • Drug Therapy, Combination
  • Drug Administration Schedule
  • Diuretics
  • Critical Illness
  • Combined Modality Therapy