L B Poveromo1, E L Michalets2, S E Sutherland3. 1. Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA. 2. Department of Pharmacy, Mission Health System, Eshelman School of Pharmacy, University of North Carolina, Asheville, NC, USA. 3. Greenville Health System Care Coordination Institute, Greenville, SC, USA.
Abstract
WHAT IS KNOWN AND OBJECTIVE: Midodrine, an orally available α1-agonist indicated for the treatment of orthostatic hypotension, has been used at our institution as an adjunctive treatment to provide haemodynamic support to facilitate intravenous (IV) vasopressor weaning. Limited published data exist for this off-label use; thus, the objective of this study was to evaluate outcomes in patients who received midodrine for IV vasopressor weaning compared to control patients. METHODS: This retrospective comparison included adult ICU patients admitted to our institution from January 2007 to March 2012. The primary outcome was the time to IV vasopressor discontinuation after midodrine initiation. Secondary outcomes included a comparison between midodrine and control patients of the time from IV vasopressor discontinuation to ICU discharge, hospital and ICU length of stay (LOS), and the number of ICU readmissions. RESULTS AND DISCUSSION: The analysis included 188 patients (94 midodrine and 94 control). Patients discontinued IV vasopressors a median of 1·2 days (IQR 0·5-2·8) after midodrine initiation. ICU discharge occurred sooner after IV vasopressor discontinuation (0·8 vs. 1·5 days, P = 0·01), and 96% of patients remained off IV vasopressors after midodrine treatment. Hospital LOS was longer in midodrine patients (P < 0·01), but there were no differences in ICU LOS or readmissions. Adverse event rates after midodrine use were consistent with those observed in other studies. WHAT IS NEW AND CONCLUSION: Midodrine may serve as a useful adjunct to wean IV vasopressors in difficult-to-wean patients. Further studies are needed to assess the efficacy and safety of midodrine for this indication.
WHAT IS KNOWN AND OBJECTIVE:Midodrine, an orally available α1-agonist indicated for the treatment of orthostatic hypotension, has been used at our institution as an adjunctive treatment to provide haemodynamic support to facilitate intravenous (IV) vasopressor weaning. Limited published data exist for this off-label use; thus, the objective of this study was to evaluate outcomes in patients who received midodrine for IV vasopressor weaning compared to control patients. METHODS: This retrospective comparison included adult ICU patients admitted to our institution from January 2007 to March 2012. The primary outcome was the time to IV vasopressor discontinuation after midodrine initiation. Secondary outcomes included a comparison between midodrine and control patients of the time from IV vasopressor discontinuation to ICU discharge, hospital and ICU length of stay (LOS), and the number of ICU readmissions. RESULTS AND DISCUSSION: The analysis included 188 patients (94 midodrine and 94 control). Patients discontinued IV vasopressors a median of 1·2 days (IQR 0·5-2·8) after midodrine initiation. ICU discharge occurred sooner after IV vasopressor discontinuation (0·8 vs. 1·5 days, P = 0·01), and 96% of patients remained off IV vasopressors after midodrine treatment. Hospital LOS was longer in midodrinepatients (P < 0·01), but there were no differences in ICU LOS or readmissions. Adverse event rates after midodrine use were consistent with those observed in other studies. WHAT IS NEW AND CONCLUSION:Midodrine may serve as a useful adjunct to wean IV vasopressors in difficult-to-wean patients. Further studies are needed to assess the efficacy and safety of midodrine for this indication.
Authors: Elizabeth M Viglianti; Sean M Bagshaw; Rinaldo Bellomo; Joanne McPeake; Daniel J Molling; Xiao Qing Wang; Sarah Seelye; Theodore J Iwashyna Journal: Chest Date: 2020-04-09 Impact factor: 9.410
Authors: Peter Santer; Matthew H Anstey; Maria D Patrocínio; Bradley Wibrow; Bijan Teja; Denys Shay; Shahzad Shaefi; Charles S Parsons; Timothy T Houle; Matthias Eikermann Journal: Intensive Care Med Date: 2020-09-03 Impact factor: 17.440
Authors: Ahmad Al-Abdouh; Sadam Haddadin; Atul Matta; Ahmad Jabri; Mahmoud Barbarawi; Waiel Abusnina; Qais Radideh; Mohammed Mhanna; Dante A Suffredini; Erin D Michos Journal: Crit Care Res Pract Date: 2021-05-15