Antifungals in Patients With Extracorporeal Membrane Oxygenation: Clinical Implications.
Lisa KrieglStefan HatzlGernot SchilcherInes Zollner-SchwetzJohannes BoyerChristina GeigerMartin HoeniglRobert KrausePublished in: Open forum infectious diseases (2024)
Extracorporeal membrane oxygenation (ECMO) is a life-saving technique used in critical care medicine for patients with severe respiratory or cardiac failure. This review examines the treatment and prophylaxis of fungal infections in ECMO patients, proposing specific regimens based on available data for different antifungals (azoles, echinocandins, amphotericin B/liposomal amphotericin B) and invasive fungal infections. Currently, isavuconazole and posaconazole have the most supported data, while modified dosages of isavuconazole are recommended in ECMO. Echinocandins are preferred for invasive candidiasis. However, choosing echinocandins is challenging due to limited and varied data on concentration loss in the ECMO circuit. Caution is likewise advised when using liposomal amphotericin B due to uncertain concentrations and potential ECMO dysfunction based on scarce data. We further conclude with the importance of further research on the impact of ECMO on antifungal drug concentrations to optimize dosing regimens in critically ill patients.
Keyphrases
- extracorporeal membrane oxygenation
- acute respiratory distress syndrome
- respiratory failure
- electronic health record
- big data
- mechanical ventilation
- candida albicans
- end stage renal disease
- newly diagnosed
- emergency department
- left ventricular
- machine learning
- risk assessment
- atrial fibrillation
- data analysis
- adverse drug
- cell wall
- respiratory tract