Title : Using midodrine to accelerate weaning of intravenous vasopressors in acute spinal cord injured patients admitted to the intensive care unit. A retrospective study of 28 patients
Abstract:
Purpose: The role of Oral midodrine has been proposed to accelerate weaning of intravenous vasopressors and discharge from the intensive care unit (ICU). However, the role of midodrine remains unclear after acute traumatic spinal cord injury (SCI) for which maintaining mean arterial pressure (MAP) targets is crucial. This study investigates whether midodrine can accelerate the weaning of intravenous vasopressors within 24 hours of its introduction.
Materials and Methods: A retrospective study with a crossover design was performed on a cohort of 28 patients with acute traumatic SCI while in the intensive care unit (ICU). The doses of intravenous vasopressors and MAP were compared from 24 hours before to 24 hours following initiation of midodrine.
Results: Midodrine was started on average 4.0±1.9 days after initiation of intravenous vasopressor therapy. Twenty-two patients (78.6%) received less intravenous vasopressors during the 24-hour period after initiation of midodrine. Mean MAP remained similar 24 hours before vs. after initiation of midodrine (90.4±3.3 vs. 88.6±5.1 mm Hg). Earlier introduction of midodrine was significantly related to more rapid weaning and reduced total duration of intravenous vasopressor therapy.
Conclusions: Initiating oral midodrine in the ICU within 7 days of a traumatic SCI resulted in a rapid decrease in intravenous vasopressor requirements in close to 80% of patients while maintaining MAP targets, therefore supporting the potential of midodrine to accelerate the weaning of intravenous vasopressors.
Keywords: Arterial blood pressure, intensive care unit, mean arterial pressure, midodrine, spinal cord injury, trauma, vasopressor
