EAT-PK: Does Extra-Corporeal Membrane Oxygenation Alter Antiinfectives Therapy Pharmacokinetics in Critically Ill Patients
Study Details
Study Description
Brief Summary
Observational study Primary Objective: To study whether ECMO alters the PK of anti-infectives including voriconazole, posaconazole and caspofungin in critically ill patients on ECMO
Secondary Objectives:
Develop Population PK models of anti-infectives, including voriconazole, posaconazole and caspofungin in critically ill patients on ECMO
Develop Physiological-Based PK (PBPK) model of anti-infectives, including: voriconazole, posaconazole and caspofungin in critically ill patients on ECMO
Study population: Critically ill patients on ECMO
Methodology: Observational study to determine whether ECMO alters the PK of anti-infectives, by developing PK models
This is a non-interventional descriptive study in that the anti-infective drug selection and dosing will be at the discretion of the clinician, based on the clinical context and unit guidelines. Doses will be reconstituted and administered as per local hospital protocols in line with patient's routine care. Patients will be asked to provide additional blood samples over the course of the anti-infective dosing schedule, these samples will be taken from existing arterial lines to help guide treatment in future patients on ECMO receiving these anti-infectives.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Detailed Description
Anti-infective drug selection and dosing will be at the discretion of the clinician, based on the clinical context and unit guidelines. Doses will be reconstituted and administered as per local hospital protocols and based on routine standard care.
Blood samples will be drawn from an existing arterial line and collected in 3 ml tubes with Lithium Heparin anticoagulant.
All patients will be sampled over a single dosing period on the second day of Extra-Corporeal Membrane Oxygenation (ECMO) treatment, or of an antibiotic course where antibiotics are commenced whilst the patient is on ECMO. Where possible, sampling during one extra dosing interval will occur on days 4-8 of ECMO treatment and/or prior to the next tubing change. Where two or more anti-infectives of interest are prescribed for one patient, collect data on timing of administration for both drugs and sample according to the antibiotic with the longer dosing interval.
Blood samples (2ml) will be collected from an existing arterial line at the following time points 0 (pre-starting infusion, pre-Nasogastric (NG)/Oral (PO) dose), 1 (end of infusion or 1hour post NG/PO dose), 2, 3, 4, 8 and either 12 (for twice daily regimen) or 24 (for once daily regimen) hours on the second day of ECMO.
Where a patient is receiving medications where a validated drug assay exists in addition to the study drug (such as other anti-infectives), analysis of the additional therapy will also be attempted where practical.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| caspofungin Adult critically ill patients on ECMO receiving caspofungin therapy |
Drug: blood drug concentration
blood drug concentration
|
| posaconazole Adult critically ill patients on ECMO receiving posaconazole therapy |
Drug: blood drug concentration
blood drug concentration
|
Outcome Measures
Primary Outcome Measures
- Area Under the Plasma Concentration Versus Time Curve (AUC) of Caspofungin in adult critically ill patients on ECMO [24 hour]
Blood samples (2ml) will be collected from an existing arterial line at the following time points 0 (pre-starting infusion, pre-NG/PO dose), 1 (end of infusion or 1hour post NG/PO dose), 2, 3, 4, 8 and either 12 (for twice daily regimen) or 24 (for once daily regimen) hours on the second day of ECMO
- Area Under the Plasma Concentration Versus Time Curve (AUC) of Posaconazole in adult critically ill patients on ECMO [24 hour]
Blood samples (2ml) will be collected from an existing arterial line at the following time points 0 (pre-starting infusion, pre-NG/PO dose), 1 (end of infusion or 1hour post NG/PO dose), 2, 3, 4, 8 and either 12 (for twice daily regimen) or 24 (for once daily regimen) hours on the second day of ECMO
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Age >18 years and <90 years
-
Currently undergoing ECMO for respiratory +/- cardiac dysfunction
-
Clinical indication for the anti-infectives, including voriconazole, posaconazole and caspofungin
Exclusion Criteria:
-
History of allergy to any of the study drug
-
Pregnant women
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Royal Brompton & Harefield NHS Foundation Trust | Harefield | Middlesex | United Kingdom | UB9 6JH |
Sponsors and Collaborators
- Royal Brompton & Harefield NHS Foundation Trust
Investigators
- Principal Investigator: Anna Reed, Royal Brompton and Harefield NHS Foundation Trust
Study Documents (Full-Text)
More Information
Publications
None provided.- 18/LO/0691