Critical Care: Critical Care - ICU Management |

Efficacy and Safety of Midodrine in a Cohort of ICU Patients FREE TO VIEW

Vrinda Trivedi, MBBS; Rahul Kashyap, MBBS; Andrea Johnson; Saraschandra Vallabhajosyula, MBBS; Devang Sanghavi, MBBS; Ognjen Gajic, MD
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Mayo Clinic, Rochester, MN

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

Chest. 2016;150(4_S):219A. doi:10.1016/j.chest.2016.08.232
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SESSION TITLE: Critical Care - ICU Management

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: To study the safety and efficacy of Midodrine to treat hypotension in critically ill patients. We hypothesized that patients would have higher mean arterial pressure (MAP) at 4 hours and 24 hours after the first dose of Midodrine.

METHODS: We performed a retrospective study of adult patients who had been initiated on Midodrine de novo in the medical and surgical intensive care units at a tertiary care center between January 2009 and January 2015. We compared median values of MAP 4 and 24 hours after administration of first dose of Midodrine to median MAP 4 hours before administration of first dose using Wilcoxon signed rank sum test. Electronic medical records were reviewed for the presence of specific side effects and complications including bradycardia, supine hypertension or bowel, coronary and cerebrovascular ischemia.

RESULTS: We identified 60 patients who received Midodrine at the clinician’s discretion to treat hypotension between day 1 to 40 of ICU admission. Dose utilized ranged from 2.5mg to 20mg every 8 hours. Median MAPs (25% to 75% Inter Quartile Range) at 4 hours before administration of Midodrine were 64 (59-70) as compared to median MAPs at 4 hours after 66 (62-72.), p=0.0062 and 24 hours after 65 (60-70), p=0.048 administration of Midodrine respectively. None of the patients had any documented side effects or complications attributed to Midodrine.

CONCLUSIONS: Midodrine is rarely used in critically ill patients. Administration of midodrine was associated with small but significant improvement in mean blood pressure and no documented side effects in our cohort.

CLINICAL IMPLICATIONS: Midodrine can be considered an option to treat hypotension in selected critically ill patients.

DISCLOSURE: The following authors have nothing to disclose: Vrinda Trivedi, Rahul Kashyap, Andrea Johnson, Saraschandra Vallabhajosyula, Devang Sanghavi, Ognjen Gajic

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