Background: The estimated incidence of acute kidney injury requiring continuous renal replacement therapy (CRRT) in patients necessitating extracorporeal membrane oxygenation (ECMO) is approximately 50%. Currently, two well-known techniques—integration and separation—are utilized for combining CRRT and ECMO circuits. The efficacy of these two techniques is still unknown. Therefore, this study aimed to compare the circuit lifespan of CRRT between the integration and separation techniques. Methods: A multicentered randomized controlled study with an unblinded design will be conducted to determine circuit lifespan differences between integration and separation techniques. Hypothesis: We hypothesize that the integration technique will yield a longer circuit lifespan for CRRT compared to the separation technique. Trial registration: NCT05036616
Abstract Background Enterococcal infective endocarditis (EIE) is associated with substantial morbidity and mortality, while optimal vancomycin pharmacodynamic targets for this condition remain uncertain. Objective To determine the association between vancomycin area under the concentration–time curve to minimum inhibitory concentration ratio (AUC/MIC) and clinical outcomes in patients with EIE. Methods This retrospective cohort study included adult patients with enterococcal infective endocarditis (EIE) who received intravenous vancomycin and had at least one measurable serum concentration. Vancomycin exposure parameters, including the 24-hour area under the concentration–time curve (AUC₀–₂₄, day 1) and steady-state AUC (AUCss), were retrospectively estimated using Bayesian modeling software and were not used to guide dose adjustment during patient care. The primary outcome was 30-day all-cause mortality, and secondary outcomes included microbiological failure and nephrotoxicity defined according to KDIGO criteria. Results A total of 120 patients with EIE were included. The optimal cut-points for predicting 30-day survival were an AUC₀–₂₄/MIC ≥ 450 and an AUCss/MIC ≥ 420. Patients achieving these thresholds had significantly lower 30-day mortality compared with those below the thresholds. Adequate vancomycin exposure remained independently associated with improved survival. A prespecified AUCss ≥ 650 mg·h/L was associated with increased nephrotoxicity. In multivariate analysis, acute renal failure, septic shock, and low vancomycin AUC/MIC were independent predictors of 30-day mortality, whereas cardiac surgery demonstrated a protective effect. Conclusions In patients with EIE, achieving AUC₀–₂₄/MIC ≥ 450 or AUCss/MIC ≥ 420 improves survival, whereas AUCss ≥ 650 mg·h/L significantly heightens nephrotoxicity risk. Early AUC-guided dose optimization and renal monitoring are crucial for balancing efficacy and safety in this high-risk population. Clinical trial registration Not applicable.
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide and results in chronic lung damage and airway obstruction, significantly impacting individual health. Apart from increased all-cause mortality, COPD exacerbations are associated with higher rates of cardiovascular (CV) events-driven by shared risk factors and pathophysiological mechanisms-with peaks in the first 30 days of post-exacerbation. Therefore, cardiopulmonary risk management is essential during this vulnerable period. This narrative review was developed through an evaluation of clinical studies, guideline recommendations and Thailand-specific data to outline cardiopulmonary linkage in COPD and propose post-COPD exacerbation management. Patient management strategies include optimized pharmacological and non-pharmacological therapies, integrated cardiopulmonary care and CV risk assessment to reduce exacerbations, mortality and CV-related events, particularly in COPD patients with established or suspected CV diseases. Furthermore, implementation of these concepts should emphasize strengthening multidisciplinary awareness among pulmonary and cardiology through professional education, continuing-development activities and integration of collaborative care into national guidelines.
