Ribavarin, BMT and nicardipine

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Stitch

Stitch

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Anyone have any experience using this drug in bone marrow transplant patients? I have an adult in my unit now the peds onc guys refuse to pass on to the adult service who's got RSV. She had been getting aerosolized ribavirin, but then we had to intubate her. Onc is pushing us to continue the treatments, but the stuff gums up his ETT and she becomes impossible to ventilate. If you do use it, how do you protect your vents from the particles?

A totally random aside question: do you consider nicardipine a negative inotrope in adult patients?
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Stitch said:
Anyone have any experience using this drug in bone marrow transplant patients? I have an adult in my unit now the peds onc guys refuse to pass on to the adult service who's got RSV. She had been getting aerosolized ribavirin, but then we had to intubate her. Onc is pushing us to continue the treatments, but the stuff gums up his ETT and she becomes impossible to ventilate. If you do use it, how do you protect your vents from the particles?

A totally random aside question: do you consider nicardipine a negative inotrope in adult patients?
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The evidence for ribavarin is crappy in RSV in all comers . . . BUT no one specifically looked at the transplant population. And I know it's only anecdote, but I think it can help in transplant situations, solid organ >> bone marrow (no bone marrow is no bone marrow :()

Let me see if I can find out from our RTs how they are putting it through out vents. I think they use a filter of some kind to help/prevent the gunking.

I would say I would consider nicardinpine to be a negative inotrope.
 
jdh71 said:
The evidence for ribavarin is crappy in RSV in all comers . . . BUT no one specifically looked at the transplant population. And I know it's only anecdote, but I think it can help in transplant situations, solid organ >> bone marrow (no bone marrow is no bone marrow :()

Let me see if I can find out from our RTs how they are putting it through out vents. I think they use a filter of some kind to help/prevent the gunking.

I would say I would consider nicardinpine to be a negative inotrope.
Click to expand...

That stuff can't be easy on vents.
 
Hernandez said:
That stuff can't be easy on vents.
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Yeah, our RTs have said no more. If it gets into the expiratory circuit, the vent is toast apparently.

jdh71 said:
The evidence for ribavarin is crappy in RSV in all comers . . . BUT no one specifically looked at the transplant population. And I know it's only anecdote, but I think it can help in transplant situations, solid organ >> bone marrow (no bone marrow is no bone marrow :()

Let me see if I can find out from our RTs how they are putting it through out vents. I think they use a filter of some kind to help/prevent the gunking.

I would say I would consider nicardinpine to be a negative inotrope.
Click to expand...

Thanks, I'd love to hear how they make it work. My patient has nearly coded twice due to sudden plugs in the ETT so we've decided the treatment is no longer worth the risk.

There were a couple of articles out recently that did look at ribavarin in the BMT population. Here are two I found that showed a significant decrease in mortality; they are what our onc docs are citing. We apparently can't get the IV form. I actually called one of centers that did these studies and asked them what their setup was. The said they don't use it in intubated patients for the same reasons we stopped.

Impact of aerosolized ribavirin on mortality in 280 allogeneic haematopoietic stem cell transplant recipients with respiratory syncytial virus infections.
Shah DP, Ghantoji SS, Shah JN, El Taoum KK, Jiang Y, Popat U, Hosing C, Rondon G, Tarrand JJ, Champlin RE, Chemaly RF.
Source
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Transpl Infect Dis. 2013 May 20. doi: 10.1111/tid.12092. [Epub ahead of print]
Successful systemic high-dose ribavirin treatment of respiratory syncytial virus-induced infections occurring pre-engraftment in allogeneic hematopoietic stem cell transplant recipients.
Gueller S, Duenzinger U, Wolf T, Ajib S, Mousset S, Berger A, Martin H, Serve H, Bug G.
Source
Department of Medicine, Hematology/Oncology, Goethe-University of Frankfurt, Frankfurt, Germany.
 
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