0
Correspondence |

Response FREE TO VIEW

Micah R. Whitson, MD; Edwin Mo, MD; Lauren Healy, PharmD; Seth Koenig, MD; Paul H. Mayo, MD; Mangala Narasimhan, DO
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

Northwell Health System, New Hyde Park, NY

CORRESPONDENCE TO: Micah R. Whitson, MD, North Shore-LIJ Health System, 270-05 76th Ave, New Hyde Park, NY 11040


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4):983-984. doi:10.1016/j.chest.2016.08.1437
Text Size: A A A
Published online

We appreciate the interest of Drs Sagar and Vijhani regarding our study, which reported our experience with midodrine use in patients recovering from septic shock. In answer to their questions:

  • 1.

    Median ICU length of stay (LOS) was 8 days in the IV vasopressor-only group and 4 days in the IV vasopressor with midodrine group (P = .017). ICU LOS was calculated using midnight bed occupancy days as recommended by Marik and Hedman (Table 1).

  • 2.

    Median Acute Physiology and Chronic Health Evaluation (APACHE IV) scores were 83 in the IV vasopressor-only group and 77.5 in the IV vasopressor with midodrine group (P = .55) (Table 2).

  • 3.

    Regarding the 18 patients discharged on midodrine, disposition and dosing were varied. Seven patients were discharged to hospice care, and one patient was transferred to another facility. Four patients were discharged home taking midodrine during hemodialysis only, which is a common safe practice. Six patients were discharged to rehabilitation centers, and the highest dosage at discharge was 10 mg tid. As these patients were discharged after transfer to the primary team from the ICU, we cannot comment on the treatment or discharge decisions regarding midodrine use. We also cannot comment on the outpatient duration, down titration, or outcomes of midodrine therapy in these patients. For a hospital inpatient, we recommend decremental titration of midodrine by 5 to 10 mg per dose on a daily basis until discontinuation while monitoring for hypotension or symptoms. If hypotension occurs, the prior stable midodrine dose should be reinstated. We do not recommend the routine use of daily midodrine for outpatients during recovery from septic shock.

Table Graphic Jump Location
Table 1 ICU and Hospital LOS

LOS = length of stay.

Table Graphic Jump Location
Table 2 Patient Demographics

APACHE = Acute Physiology and Chronic Health Evaluation.

We appreciate the opportunity to further explain our findings in what we believe to be a useful tool to improve ICU resource allocation.

References

Whitson M.R. .Mo E. .Nabi T. .et al Feasibility, utility, and safety of midodrine during recovery phase from septic shock. Chest. 2016;149:1380-1383 [PubMed]journal. [CrossRef] [PubMed]
 
Marik P.E. .Hedman L. . What's in a day? Determining intensive care unit length of stay. Crit Care Med. 2000;28:2090-2093 [PubMed]journal. [CrossRef] [PubMed]
 
Prakash S. .Garg A.X. .Heidenheim A.P. .et al Midodrine appears to be safe and effective for dialysis-induced hypotension: a systematic review. Nephrol Dial Transplant. 2004;19:2553-2558 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 ICU and Hospital LOS

LOS = length of stay.

Table Graphic Jump Location
Table 2 Patient Demographics

APACHE = Acute Physiology and Chronic Health Evaluation.

References

Whitson M.R. .Mo E. .Nabi T. .et al Feasibility, utility, and safety of midodrine during recovery phase from septic shock. Chest. 2016;149:1380-1383 [PubMed]journal. [CrossRef] [PubMed]
 
Marik P.E. .Hedman L. . What's in a day? Determining intensive care unit length of stay. Crit Care Med. 2000;28:2090-2093 [PubMed]journal. [CrossRef] [PubMed]
 
Prakash S. .Garg A.X. .Heidenheim A.P. .et al Midodrine appears to be safe and effective for dialysis-induced hypotension: a systematic review. Nephrol Dial Transplant. 2004;19:2553-2558 [PubMed]journal. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543