tailieunhanh - Báo cáo khoa học: "Pharmacotherapy during neonatal extracorporeal membrane oxygenation: toward an evidence-based approach"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Pharmacotherapy during neonatal extracorporeal membrane oxygenation: toward an evidence-based approach. | Available online http content 11 1 107 Commentary Pharmacotherapy during neonatal extracorporeal membrane oxygenation toward an evidence-based approach Maissa Rayyan and Karel Allegaert Department of Woman and Child University of Leuven Herestraat 49 3000 Leuven Belgium Corresponding author Karel Allegaert Published 14 February 2007 This article is online at http content 11 1 107 2007 BioMed Central Ltd Critical Care 2007 11 107 doi cc5151 See related research by Van der Vorst et al. http content 10 6 R168 Abstract Van der Vorst and coworkers recently illustrated the large variability in furosemide regimens used in their unit. This finding at least suggests that we need more data on the pharmacokinetics and pharmacodynamics of this drug in neonates during treatment with extracorporeal membrane oxygenation in order to ensure quality of care and safety and to promote evidence-based prescription. The implementation of population pharmacokinetic models can further increase both the feasibility of such studies and the relevance of the results generated. Although the general principles of clinical pharmacology apply to neonates and young infants the characteristics of this population warrant a specific approach. The relative body water content fat distribution and muscle mass are markedly different in foetal than in neonatal and paediatric groups. Almost all phase 1 and phase 2 hepatic clearance processes have a distinct isoenzyme-specific ontogeny whereas renal clearance in early neonatal life is limited and depends almost entirely on glomerular filtration rate the result of these factors is that the body s clearance of pharmacological agents evolves in a drug-specific age-dependent manner. Extracorporeal membrane oxygenation ECMO further affects the pharmacokinetics and pharmacodynamics PK PD of drugs. It is therefore mandatory that populationspecific data in neonates on drug-specific PK PD .