2026-04-13T05:55:37Zhttps://recercat.cat/oai/request
oai:recercat.cat:11351/137802025-10-24T08:51:33Zcom_2072_378070com_2072_378040com_2072_378071col_2072_378092col_2072_378097
RECERCAT author Sosa, Manuel author Puertas Sanjuan, Adrian author Bonilla, Camilo author Faixó, Patricia author Guevara Chaux, Jessica Alejandra author Vilanova, Albert author Martínez-Pla, María author Conto, Aldair author Nuvials, Xavier author Doménech-Moral, Laura author García García, Sonia author Pau-Parra, Alba author Gallart Vivé, Elisabet author Castellote Bellés, Laura author Lalueza-Broto, Pilar author Ferrer, Ricard author Gorgas, Maria Queralt author Riera del Brio, Jordi 2025-10-24T08:51:33Z 2025-10-24T08:51:33Z 2025-10-06T08:01:13Z2025-10-06T08:01:13Z2025-06 http://hdl.handle.net/11351/13780 Antifungal therapy; Critical care; PharmacokineticsTeràpia antifúngica; Cures intensives; FarmacocinèticaTerapia antifúngica; Cuidados intensivos; FarmacocinéticaBackground/objectives: Extracorporeal membrane oxygenation (ECMO) is increasingly used in critically ill patients, but may significantly alter the pharmacokinetics (PK) of antifungals. Data on plasma concentrations of Isavuconazole (IsaPlasm) in ECMO patients are limited. Our objective is to evaluate Isavuconazole exposure and variability in critically ill COVID-19 patients receiving ECMO. Methods: We conducted a pharmacokinetic analysis of Isavuconazole in critically ill patients receiving Veno-Venous ECMO for respiratory support. Plasma concentrations were measured using therapeutic drug monitoring (TDM) at multiple time points, including sampling before and after the membrane oxygenator. PK parameters-Area Under Curve (AUC0-24), Minimum Plasma Concentration (Cmin), Elimination Half-Life (T1/2), volume of distribution (Vd), and clearance (CL)-were estimated and compared with published data in non-ECMO populations. Results: Five patients were included. The median AUC0-24 was 227.3 µg·h/mL (IQR 182.4-311.35), higher than reported in non-ECMO patients. The median Vd was 761 L (727-832), suggesting extensive peripheral distribution and potential drug sequestration in the ECMO circuit. CL was increased (1.6 L/h, IQR 1.5-3.4). Two patients with recently replaced ECMO circuits exhibited significant drug loss across the membrane. Obesity and hypoalbuminemia were identified as factors associated with altered drug exposure. Conclusions: Isavuconazole pharmacokinetics show marked variability in critically ill ECMO patients. Increased AUC and Vd, along with reduced clearance, highlight the need for individualized dosing. Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess Medicaments antifúngics - Farmacocinètica Medicaments - Monitoratge Teràpia respiratòria Malalts en estat crític CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antifungal Agents Other subheadings::Other subheadings::Other subheadings::/pharmacokinetics ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Respiratory Therapy::Extracorporeal Membrane Oxygenation DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Critical Illness ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Monitoring, Physiologic::Drug Monitoring COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antifúngicos Otros calificadores::Otros calificadores::Otros calificadores::/farmacocinética TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::terapia respiratoria::oxigenación por membrana extracorpórea ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::atributos de la enfermedad::enfermedad crítica TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::monitorización fisiológica::monitorización de medicamentos Pharmacokinetics of Isavuconazole During Extracorporeal Membrane Oxygenation Support in Critically Ill Patients: A Case Series info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion