目的:本研究旨在确定充氧器对包括Quadrox-i充氧器在内的当代新生儿/儿科(1/4英寸)和青少年/成人(3/8英寸)体外膜-氧合(ECMO)回路中瑞德西韦(RDV)改变的影响。
方法:四分之一英寸和3/8英寸,用Quadrox-i儿科和Quadrox-i成人充氧器和血液灌注准备模拟闭环ECMO回路。此外,还制备了1/4英寸和3/8英寸的电路,没有串联的充氧器。将1次剂量的RDV施用到回路中,并在0至5分钟时获得连续的预充氧剂和充氧剂浓度,1-,2-,3-,4-,5-,6-,8-,12-,和24小时的时间点。还将RDV保持在玻璃小瓶中,并且在相同的时间段从小瓶中取样用于对照目的以评估自发的药物降解。
结果:对于带充氧器的1/4英寸电路,在研究期间有35%至60%的RDV损失。对于没有充氧器的1/4英寸电路,在研究期间有5%至20%的RDV损失。对于带和不带充氧器的3/8英寸电路,在研究期间有60%至70%的RDV损失。
结论:在研究期间,电路内存在RDV损失,与1/4英寸电路相比,较大的3/8英寸电路RDV损失更明显。-氧合器对RDV损失的影响似乎是可变的,并且可能取决于电路和-氧合器的大小。这些初步数据表明,可能需要调整RDV剂量,以考虑通过ECMO回路的药物损失。需要额外的单剂量和多剂量研究来验证这些发现。
OBJECTIVE: This study aimed to determine the oxygenator impact on alterations of remdesivir (RDV) in a contemporary neonatal/pediatric (1/4-inch) and adolescent/adult (3/8-inch) extracorporeal membrane -oxygenation (ECMO) circuit including the Quadrox-i oxygenator.
METHODS: One-quarter-inch and a 3/8-inch, simulated closed-loop ECMO circuits were prepared with a Quadrox-i pediatric and Quadrox-i adult oxygenator and blood primed. Additionally, 1/4-inch and 3/8-inch circuits were also prepared without an oxygenator in series. A 1-time dose of RDV was administered into the circuits and serial preoxygenator and postoxygenator concentrations were obtained at 0 to 5 minutes, and 1-, 2-, 3-, 4-, 5-, 6-, 8-, 12-, and 24-hour time points. The RDV was also maintained in a glass vial and samples were taken from the vial at the same time periods for control purposes to assess for spontaneous drug degradation.
RESULTS: For the 1/4-inch circuits with an oxygenator, there was a 35% to 60% RDV loss during the study period. For the 1/4-inch circuits without an oxygenator, there was a 5% to 20% RDV loss during the study period. For the 3/8-inch circuit with and without an oxygenator, there was a 60% to 70% RDV loss during the study period.
CONCLUSIONS: There was RDV loss within the circuit during the study period and the RDV loss was more pronounced with the larger 3/8-inch circuit when compared with the 1/4-inch circuit. The impact of the -oxygenator on RDV loss appears to be variable and possibly dependent on the size of the circuit and -oxygenator. These preliminary data suggest RDV dosing may need to be adjusted for concern of drug loss via the ECMO circuit. Additional single- and multiple-dose studies are needed to validate these findings.