Indications for Continuation of Alpha-1 Agonist Midodrine Upon ICU Discharge
Hussain, Fahad, MSII; Rao, Deepti, MD
Persistent hypotension in patients affected by circulatory shock is a common barrier to discharge in the ICU. Even after these patients have been otherwise stabilized, low-level hypotension often ensures that they remain in the ICU on IV vasopressors. Midodrine, an oral α1-agonist, has shown promise as an adjunct therapy to wean patients off IV vasopressors and facilitate earlier discharge from the ICU. According to a recent study done at the Mayo Clinic ICU, Rochester, discharge on Midodrine was associated with a shorter ICU length of stay as well as a decreased in-hospital mortality rate. However, it was also associated with an increased 1-year mortality rate. Additionally, the same study found that, among the patients discharged from the ICU on Midodrine, 50% were concomitantly started on some form of medication to lower blood pressure while still on Midodrine. This counterintuitive practice, coupled with the increased 1-year mortality rate seen with prescribed Midodrine, raises the question of why the medication is being continued at discharge. This study will seek to determine the indications for continuation of Midodrine upon ICU discharge. Additionally, the methods physicians are currently employing to taper or discontinue Midodrine outside of the ICU will be analyzed.
In this retrospective chart review, data from ICU patients with persistent hypotension treated with Midodrine, at the University of New Mexico Hospital, will be analyzed. Specifically, records will be reviewed to obtain data regarding details of Midodrine treatment (date started and ended, dosing, blood pressure during use, taper schedule, incidence of continuation upon discharge). Other variables considered will include ICU length of stay, ICU mortality on Midodrine, adverse events related to Midodrine use, and incidence of patients discharged on Midodrine concurrently with anti-hypertensives. We will use this data to understand the reasons for which physicians are choosing to continue patients on Midodrine after discharge. Moreover, we will examine the strategies used by different physicians to taper or discontinue Midodrine outside of the ICU. Our study has received IRB approval by the University of New Mexico.
The effects of Midodrine on patients discharged from the ICU is an area of active research and much is still unknown. As a result, it is important to examine the current basis for which a determination is made to prescribe Midodrine as well as compile the strategies used to discontinue or taper the medication. Currently, we are in the process of reviewing charts to gather data regarding details of Midodrine treatment in ICU patients at the University of New Mexico. Once an adequate amount of data is collected, appropriate statistical analyses will be run. Ultimately, the goal is to publish our findings as a guidance to physicians considering discharging a patient on Midodrine.
Persistent hypotension, in an ICU setting, is often a significant barrier to discharge for many patients. Midodrine, an oral α1-agonist, has been proposed as a therapy to wean patients from IV vasopressors, facilitate earlier discharge, and maintain blood pressure outside of the ICU. Although there is very little data regarding indications for continuation of Midodrine upon ICU
Hussain, Fahad and Deepti S. Rao. "Continuation of Midodrine Upon ICU Discharge." (2020). https://digitalrepository.unm.edu/hsc_qips/52