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Safety of Oral Midodrine as a Method of Weaning From Intravenous Vasoactive Medication in the Medical Intensive Care Unit FREE TO VIEW

Jose Luis Cardenas-Garcia; Micah Withson; Lauren Healy; Seth Koenig; Managala Narasimhan; Paul Mayo
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Hofstra North Shore - LIJ School of Medicine, New York, NY

Chest. 2014;146(4_MeetingAbstracts):224A. doi:10.1378/chest.1990326
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SESSION TITLE: Non Pulmonary Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: We evaluated the safety of oral midodrine administered to medical intensive care unit (MICU) patients as a method of weaning from intravenous vasoactive medication (IVM).

METHODS: For a six-month period starting in March 2013, we monitored use of oral midodrine in an 18-bed MICU. Patients who continued to require low to moderate doses of a single IVM but who could not be weaned from the agent, were started on oral midodrine in order to reduce IVM dose. Midodrine dose was increased until IVM was no longer required. Following transfer from MICU, midodrine was reduced as tolerated by the regular floor team. Data was collected prospectively on a daily basis by one investigator and entered into a standard de-identified data sheet for safety assessment.

RESULTS: Fifty patients (age 69.3+/-17, male/female 30:20, SAPS II score 57.6+/-16.5) received oral midodrine. IVM used: phenylephrine (19), norepinephrine (17), dopamine (11), dobutamine (2), and vasopressin (1). Average length of stay (LOS) in MICU was 7.6+/-5.2 days; 17 patients had central intravenous access (CIVA), removed when weaned off IVM; initial and maximal doses of midodrine in MICU were 30.5+/-18.5 and 66.6+/-41.4 mg/day respectively with no adverse effects observed; 27 (54%) patients were discharged from the hospital on a midodrine dose of 17.8+/-31.6 mg/day.

CONCLUSIONS: Oral administration of midodrine at the reported doses is safe in the MICU. Its use may reduce the need for IVM, thereby decreasing MICU LOS and need for CIVA. Our results suggest that in patients who continue to require low to moderate doses of a single IVM may be safely converted to oral midodrine. This report is preliminary, as it remains to be determined how to define the patient population for whom midodrine is appropiate.

CLINICAL IMPLICATIONS: Use of oral midodrine may reduce the duration of IVM administration, allowing both earlier MICU transfer and discontinuation of CIVA. This approach may have potential for risk reduction in the MICU.

DISCLOSURE: The following authors have nothing to disclose: Jose Luis Cardenas-Garcia, Micah Withson, Lauren Healy, Seth Koenig, Managala Narasimhan, Paul Mayo

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