Gramish Jawaher, Hattan Ahmed, Aljuhani Ohoud, Parameaswari P J, Alshehri Shaden, Korayem Ghazwa B, Alkofide Hadeel, Alalawi Mai, Vishwakarma Ramesh, Alsowaida Yazed Saleh, Alqahtani Rahaf, Binorayir Luluh, Abutaleb Mohammed, Alotaibi Alanoud, Aljohani Majidah, Aljohani Sarah, Samreen Sana, Jawhari Suad, Alanazi Raghad, Al Sulaiman Khalid A
Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Ann Pharmacother. 2024 Mar;58(3):223-233. doi: 10.1177/10600280231173290. Epub 2023 May 29.
Midodrine has been used in the intensive care unit (ICU) setting to reduce the time to vasopressor discontinuation. The limited data supporting midodrine use have led to variability in the pattern of initiation and discontinuation of midodrine.
To compare the effectiveness and safety of 2 midodrine discontinuation regimens during weaning vasopressors in critically ill patients.
A retrospective cohort study was conducted at King Abdulaziz Medical City. Included patients were adults admitted to ICU who received midodrine after being unable to be weaned from intravenous vasopressors for more than 24 hours. Patients were categorized into two subgroups depending on the pattern of midodrine discontinuation (tapered dosing regimen vs. nontapered regimen). The primary endpoint was the incidence of inotropes and vasopressors re-initiation after midodrine discontinuation.
The incidence of inotropes or vasopressors' re-initiation after discontinuation of midodrine was lower in the tapering group (15.4%) compared with the non-tapering group (40.7%) in the crude analysis as well as regression analysis (odd ratio [OR] = 0.15; 95% CI = 0.03, 0.73, = 0.02). The time required for the antihypertensive medication(s) initiation after midodrine discontinuation was longer in patients who had dose tapering (beta coefficient (95% CI): 3.11 (0.95, 5.28), = 0.005). Moreover, inotrope or vasopressor requirement was lower 24 hours post midodrine initiation. In contrast, the two groups had no statistically significant differences in 30-day mortality, in-hospital mortality, or ICU length of stay.
These real-life data showed that tapering midodrine dosage before discontinuation in critically ill patients during weaning from vasopressor aids in reducing the frequency of inotrope or vasopressor re-initiation. Application of such a strategy might be a reasonable approach among ICU patients unless contraindicated.
去氧肾上腺素已用于重症监护病房（ICU），以缩短停用血管升压药的时间。支持使用去氧肾上腺素的数据有限，导致去氧肾上腺素的起始和停用模式存在差异。
比较两种去氧肾上腺素停药方案在危重症患者撤停血管升压药期间的有效性和安全性。
在阿卜杜勒阿齐兹国王医疗城进行了一项回顾性队列研究。纳入的患者为入住ICU的成年人，在无法从静脉血管升压药撤机超过24小时后接受了去氧肾上腺素治疗。根据去氧肾上腺素的停药模式（逐渐减量给药方案与非逐渐减量方案）将患者分为两个亚组。主要终点是去氧肾上腺素停药后血管活性药物和血管升压药重新起始的发生率。
在粗分析和回归分析中，逐渐减量组去氧肾上腺素停药后血管活性药物或血管升压药重新起始的发生率（15.4%）低于非逐渐减量组（40.7%）（比值比[OR]=0.15；95%置信区间=0.03，0.73，P=0.02）。去氧肾上腺素停药后开始使用抗高血压药物所需的时间在采用剂量逐渐减量的患者中更长（β系数（95%置信区间）：3.11（0.95，5.28），P=0.005）。此外，去氧肾上腺素起始后24小时血管活性药物或血管升压药的需求较低。相比之下，两组在30天死亡率、住院死亡率或ICU住院时间方面无统计学显著差异。
这些实际数据表明，在危重症患者撤停血管升压药期间，停用去氧肾上腺素前逐渐减量有助于降低血管活性药物或血管升压药重新起始的频率。除非有禁忌证，在ICU患者中应用这种策略可能是一种合理的方法。
