Machines that help machines to help patients: optimising antimicrobial dosing in patients receiving extracorporeal membrane oxygenation and renal replacement therapy using dosing software

Jason A. Roberts, Rinaldo Bellomo, Menino O. Cotta, Birgit C.P. Koch, Haifa Lyster, Marlies Ostermann, Claire Roger, Kiran Shekar, Kevin Watt, Mohd H. Abdul-Aziz

Research output: Contribution to journalReview ArticleResearchpeer-review

19 Citations (Scopus)


Intensive care unit (ICU) patients with end-organ failure will require specialised machines or extracorporeal therapies to support the failing organs that would otherwise lead to death. ICU patients with severe acute kidney injury may require renal replacement therapy (RRT) to remove fluid and wastes from the body, and patients with severe cardiorespiratory failure will require extracorporeal membrane oxygenation (ECMO) to maintain adequate oxygen delivery whilst the underlying pathology is evaluated and managed. The presence of ECMO and RRT machines can further augment the existing pharmacokinetic (PK) alterations during critical illness. Significant changes in the apparent volume of distribution (Vd) and drug clearance (CL) for many important drugs have been reported during ECMO and RRT. Conventional antimicrobial dosing regimens rarely consider the impact of these changes and consequently, are unlikely to achieve effective antimicrobial exposures in critically ill patients receiving ECMO and/or RRT. Therefore, an in-depth understanding on potential PK changes during ECMO and/or RRT is required to inform antimicrobial dosing strategies in patients receiving ECMO and/or RRT. In this narrative review, we aim to discuss the potential impact of ECMO and RRT on the PK of antimicrobials and antimicrobial dosing requirements whilst receiving these extracorporeal therapies. The potential benefits of therapeutic drug monitoring (TDM) and dosing software to facilitate antimicrobial therapy for critically ill patients receiving ECMO and/or RRT are also reviewed and highlighted.

Original languageEnglish
Pages (from-to)1338–1351
Number of pages14
JournalIntensive Care Medicine
Issue number10
Publication statusPublished - Oct 2022


  • Antimicrobial
  • Dosing software
  • Extracorporeal membrane oxygenation
  • Pharmacokinetics
  • Renal replacement therapy
  • Therapeutic drug monitoring

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