{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T23:38:48Z","timestamp":1790379528584,"version":"4.1.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2014,12,12]],"date-time":"2014-12-12T00:00:00Z","timestamp":1418342400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2014,12,12]],"date-time":"2014-12-12T00:00:00Z","timestamp":1418342400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                        <jats:title>Introduction<\/jats:title>\n                        <jats:p>The scope of extracorporeal membrane oxygenation (ECMO) is expanding; however, optimal drug prescription during ECMO remains a developing science. Currently, there are no clear guidelines for antibiotic dosing during ECMO. This open-label, descriptive, matched-cohort pharmacokinetics (PK) study aimed to compare the PK of meropenem in ECMO patients to critically ill patients with sepsis not receiving ECMO (controls).<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Methods<\/jats:title>\n                        <jats:p>Eleven adult patients on ECMO (venovenous (VV) ECMO, n\u2009=\u20096; venoarterial (VA) ECMO, n\u2009=\u20095) receiving intravenous (IV) meropenem were included. Meropenem plasma concentrations were determined using validated chromatography. Population PK analysis was performed using non-linear mixed effects modelling. This data was compared with previously published meropenem PK data from 10 critically ill adult patients not on ECMO (preserved renal function (n\u2009=\u20095) or receiving renal replacement therapy (RRT) (n\u2009=\u20095). Using these data, we then performed Monte Carlo simulations (n\u2009=\u20091,000) to describe the effect of creatinine clearance on meropenem plasma concentrations.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Results<\/jats:title>\n                        <jats:p>In total, five (two VV, three VA) out of eleven ECMO patients received RRT. The other six patients (four VV, two VA) had no significant impairment in renal function. A two-compartment model adequately described the data. ECMO patients had numerically higher volume of distribution (0.45\u2009\u00b1\u20090.17 versus 0.41\u2009\u00b1\u20090.13\u00a0L\/kg, <jats:italic>P<\/jats:italic>\u2009=\u20090.21) and lower clearance compared to controls (7.9\u2009\u00b1\u20095.9 versus 11.7\u2009\u00b1\u20096.5\u00a0L\/h, <jats:italic>P<\/jats:italic>\u2009=\u20090.18). Variability in meropenem clearance was correlated with creatinine clearance or the presence of RRT. The observed median trough concentrations in the controls were 4.2 (0.0 to 5.7) mg\/L. In ECMO patients, while trough meropenem concentrations &gt;2\u00a0mg\/L were achieved in all patients, a more aggressive target of &gt;8\u00a0mg\/L for less susceptible microorganisms was observed in only eight out of eleven patients, with five of them being on RRT.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Conclusions<\/jats:title>\n                        <jats:p>ECMO patients exhibit high PK variability. Decreased meropenem CL on ECMO appears to compensate for ECMO and critical illness-related increases in volume of distribution. Routine target concentrations &gt;2\u00a0mg\/L are maintained with standard dosing (1\u00a0g IV 8-hourly). However, an increase in dose may be necessary when targeting higher concentrations or in patients with elevated creatinine clearance.<\/jats:p>\n                     <\/jats:sec>","DOI":"10.1186\/s13054-014-0565-2","type":"journal-article","created":{"date-parts":[[2014,12,11]],"date-time":"2014-12-11T14:41:39Z","timestamp":1418308899000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":98,"title":["The combined effects of extracorporeal membrane oxygenation and renal replacement therapy on meropenem pharmacokinetics: a matched cohort study"],"prefix":"10.1186","volume":"18","author":[{"given":"Kiran","family":"Shekar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F","family":"Fraser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio Silvio","family":"Taccone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Welch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven C","family":"Wallis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel V","family":"Mullany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Lipman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason A","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2014,12,12]]},"reference":[{"key":"565_CR1","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1186\/cc13865","volume":"18","author":"K Shekar","year":"2014","unstructured":"Shekar K, Mullany DV, Thomson B, Ziegenfuss M, Platts DG, Fraser JF: Extracorporeal life support devices and strategies for management of acute cardiorespiratory failure in adult patients: a comprehensive review. 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