Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN.
Crit Care Med. 2018 Jul;46(7):e628-e633. doi: 10.1097/CCM.0000000000003121.
Midodrine is an oral alpha-agonist approved for orthostatic hypotension. The use of midodrine as a vasopressor sparing agent has steadily increased in the ICU despite limited evidence for its safety in that setting. We describe the trends in use and reported side effects and complications of midodrine in multidisciplinary ICUs of a tertiary care institution.
Single-center retrospective case series.
Medical and surgical ICU patients from January 2011 to October 2016 at Mayo Clinic, Rochester.
Adult patients admitted to any ICU who received midodrine for hypotension were eligible.
None.
We reviewed the mean arterial pressures and cumulative vasopressor dose before and after midodrine administration and assessed for reported complications. During the study period, a total of 1,119 patients were initiated on midodrine, 56% in surgical ICUs, 42% in medical ICUs, and 2% in a mixed medical and surgical neurology ICU. There was a significant decrease in the number of patients on vasopressors 24 hours after initiation of midodrine (663 to 344; p < 0.001); among the patients that remained on vasopressors, there was a significant decrease in the median cumulative vasopressor dose (p = 0.002). There was a significant increase in median mean arterial pressure 24 hours after initiation of midodrine among patients who were not on vasopressors (65-68; p < 0.01). Asymptomatic bradycardia (heart rate < 50 beats/min) was the most common side effect (n = 172 patients, median 39 beats/min). Two patients developed bowel ischemia after initiation of midodrine that prompted discontinuation of midodrine in one case. Evaluating trends of utilization, the off-label use of midodrine has increased steadily over the years across ICUs.
Our results suggest that midodrine is being increasingly used as an adjunct to increase mean arterial pressure and facilitate weaning of vasopressors in the ICU. Prospective trials are required to further establish the appropriate timing, efficacy, safety, and cost-effectiveness of midodrine use in ICU patients.
米多君是一种批准用于体位性低血压的口服α激动剂。尽管在该环境下其安全性的证据有限，但米多君作为血管加压素保留剂的使用在重症监护病房（ICU）中稳步增加。我们描述了在一家三级保健机构的多学科 ICU 中米多君的使用趋势以及报告的副作用和并发症。
单中心回顾性病例系列。
梅奥诊所罗切斯特医疗和外科 ICU 患者，2011 年 1 月至 2016 年 10 月。
接受低血压米多君治疗的任何 ICU 成人患者。
无。
我们回顾了米多君给药前后的平均动脉压和累积血管加压剂剂量，并评估了报告的并发症。在研究期间，共有 1119 例患者开始使用米多君，其中 56%在外科 ICU，42%在内科 ICU，2%在混合内科和外科神经科 ICU。米多君开始后 24 小时接受血管加压剂治疗的患者数量显著减少（663 例降至 344 例；p<0.001）；在继续接受血管加压剂治疗的患者中，累积血管加压剂剂量中位数显著减少（p=0.002）。米多君开始后 24 小时，未接受血管加压剂治疗的患者的平均动脉压中位数显著升高（65-68mmHg；p<0.01）。无症状性心动过缓（心率<50 次/分钟）是最常见的副作用（172 例患者，中位数 39 次/分钟）。两名患者在开始米多君后发生肠缺血，其中一名患者停用米多君。评估使用趋势，米多君的非适应证使用多年来在各 ICU 中稳步增加。
我们的结果表明，米多君作为增加平均动脉压和促进 ICU 中血管加压剂撤药的辅助药物越来越多地被使用。需要前瞻性试验进一步确定 ICU 患者使用米多君的适当时机、疗效、安全性和成本效益。
