Kamah Ellena, PharmD,
Spectrum Health Butterworth Hospital
Grand Rapids, MI
Disclosure information not submitted.
Jenna Combs, PharmD, BCPS
Clinical Pharmacist
Mercy Health Saint Mary's, United States
Disclosure information not submitted.
Heather Draper, PharmD, BCPS
Clinical Pharmacist
Mercy Health Saint Mary's, United States
Disclosure information not submitted.
Julie Belfer, BCCCP, BCPS, PharmD
Clinical Pharmacist
Mercy Health Saint Marys, United States
Disclosure information not submitted.
Title: Role of Midodrine on Vasopressor Duration in Patients With Sepsis
Introduction/Hypothesis:Existing literature evaluating off-label use of midodrine for liberation of vasopressors has focused primarily on postoperative hypotensive patients requiring a single vasopressor. The purpose of this study was to evaluate the impact of midodrine on vasopressor duration, intensive care unit (ICU) and hospital length of stay (LOS), and cost of therapy in patients receiving vasopressors for sepsis related hypotension.
Methods: This retrospective cohort study compared critically ill patients who received midodrine and vasopressors for hypotension secondary to sepsis compared to patients who received vasopressors alone. Adult patients were included if admitted to the critical care service with a diagnosis of sepsis and received intravenous vasopressors for at least eight hours. Patients in the midodrine group must have received three or more doses of midodrine for inclusion. Patients were matched by APACHE II score, suspected source of infection and presence of bacteremia.
Results: One hundred patients were included in the analysis. Fifty patients were randomized to the midodrine group and fifty patients were matched into the vasopressor only group. There were no major differences in baseline variables. The median duration of vasopressors in the midodrine group was 36 hours (IQR 18.9375-61.9375) compared to 26 hours (IQR 13.75-59.875) in the vasopressor only group (p = 0.127). Patients in the midodrine group were in the ICU for a median of 3.9 days compared to 2.6 days in the vasopressor only group (p = 0.017). Midodrine patients had a median hospital LOS that was 3.7 days longer than the vasopressor only group (p = 0.008). The median cost of therapy for the midodrine group was $18.13 compared to $36.73 for the vasopressor group (p = 0.495). Sixteen percent of patients were discharged on midodrine without an indication for therapy.
Conclusions: Initiation of midodrine in patients undergoing vasopressor wean did not decrease time to vasopressor discontinuation, LOS, or medication cost of therapy in patients with sepsis. Patients should be assessed at transitions of care for midodrine discontinuation to avoid presence at discharge.