Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Department of Pharmacy, Mayo Clinic, Rochester, MN.
Crit Care Med. 2019 Aug;47(8):e648-e653. doi: 10.1097/CCM.0000000000003814.
Midodrine is an α1-agonist approved for orthostatic hypotension. Recently, it has received attention as an oral vasopressor to facilitate ICU discharge. The purpose of this study was to identify the incidence of continuation of newly initiated midodrine upon ICU and hospital discharge and identify risk factors associated with its occurrence.
Single-center retrospective study.
ICU patients from January 2011 to October 2016 at Mayo Clinic, Rochester.
Adult patients admitted to any ICU who received new midodrine for hypotension and survived to discharge.
None.
During the study period, 1,010 patients were newly started on midodrine and survived to ICU discharge. Midodrine was continued in 67% (672/1,010) of patients at ICU discharge. Admission to cardiovascular surgery ICU and mixed medical/surgical ICU was a risk factor for midodrine continuation at ICU discharge (odds ratio, 3.94 [2.50-6.21] and 2.03 [1.29-3.20], respectively). At hospital discharge, 34% (311/909) of patients were continued on midodrine therapy. History of congestive heart failure predicted midodrine continuation at hospital discharge (odds ratio, 1.49 [1.05-2.12]). Hypertension and use of mechanical ventilation were associated with a decreased odds of midodrine prescription at both ICU and hospital discharge. Of those discharged from the ICU or hospital on midodrine, 50% were concomitantly prescribed antihypertensives. Discharge from the ICU on midodrine was associated with a significantly shorter ICU length of stay (7.5 ± 8.9 vs 10.6 ± 13.4 d) and reduced risk of in-hospital mortality (hazard ratio, 0.47 [95% CI, 0.32-0.70]; p < 0.001), despite no difference in baseline severity of illness scores. In contrast, patients discharged from the hospital on midodrine had a higher risk of 1-year mortality (hazard ratio, 1.60 [95% CI, 1.26-2.04]; p < 0.001).
This study established a high prevalence of midodrine continuation in transitions of care. The risks and benefits of this practice remain unclear. Future studies should explore the impact of this practice on patient outcomes and resource utilization. These insights could be used to model interventions for proper tapering, discontinuation, or follow-up of new start midodrine.
米多君是一种用于治疗直立性低血压的α1-激动剂。最近，它作为一种口服升压药，有助于 ICU 患者出院，受到了关注。本研究的目的是确定 ICU 和出院时新开始使用米多君的继续使用情况，并确定与其发生相关的危险因素。
单中心回顾性研究。
梅奥诊所罗切斯特院区的 ICU 患者，时间为 2011 年 1 月至 2016 年 10 月。
低血压新接受米多君治疗且存活至出院的 ICU 入院患者。
无。
在研究期间，1010 例患者新开始使用米多君并存活至 ICU 出院。67%（672/1010）的患者在 ICU 出院时继续使用米多君。入心血管外科 ICU 和混合内科/外科 ICU 是 ICU 出院时继续使用米多君的危险因素（优势比，3.94[2.50-6.21]和 2.03[1.29-3.20]）。出院时，34%（311/909）的患者继续接受米多君治疗。充血性心力衰竭史预测出院时继续使用米多君（优势比，1.49[1.05-2.12]）。高血压和使用机械通气与 ICU 和出院时米多君处方减少的几率相关。在 ICU 或医院出院时服用米多君的患者中，有 50%同时服用降压药。在 ICU 服用米多君出院与 ICU 住院时间明显缩短（7.5±8.9 天 vs. 10.6±13.4 天）和院内死亡率降低（风险比，0.47[95%CI，0.32-0.70]；p<0.001）相关，尽管基线严重程度评分无差异。相比之下，出院时服用米多君的患者 1 年死亡率较高（风险比，1.60[95%CI，1.26-2.04]；p<0.001）。
本研究确定了在治疗过渡期米多君继续使用的高发生率。这种做法的风险和益处尚不清楚。未来的研究应探讨这种做法对患者结局和资源利用的影响。这些见解可用于对新开始米多君进行适当的逐渐减少、停药或随访的干预措施建模。
