A 45-year-old woman with severe ARDS on VV-ECMO develops new left-sided consolidation with air bronchograms on CXR. She is receiving 'rest settings' o...

Question

A 45-year-old woman with severe ARDS on VV-ECMO develops new left-sided consolidation with air bronchograms on CXR. She is receiving 'rest settings' on the ventilator: PCV, Pinsp 10 cmH2O, PEEP 10 cmH2O, FiO2 0.3, RR 10/min. Tracheal aspirate grows Pseudomonas aeruginosa. When dosing antibiotics for a patient on ECMO, what pharmacokinetic consideration is most important?

Accepted Answer

ECMO increases the volume of distribution (Vd) for hydrophilic drugs due to circuit sequestration and haemodilution, potentially requiring higher loading doses and therapeutic drug monitoring

Answer

No dose adjustment is needed on ECMO

Answer

All antibiotic doses should be halved due to reduced renal clearance

Answer

Lipophilic drugs require dose reduction on ECMO

Answer

Antibiotics are ineffective during ECMO and should not be given

uk-fficm MCQ (SBA): ECMO Pharmacokinetics