Use of midodirine in taper inotropic drug in patients admitted to ICU

Abstract

Patients admitted to the Intensive Care Unit (ICU) are often treated with intravenous (IV) vasopressors. Persistent hypotension and dependency on IV vasopressors in resuscitated patients lead to delayed ICU discharge, which can increase the health and economic burden on individuals and the community health system. The administration of midodrine, by accelerating the discontinuation of vasopressor medications and consequently speeding up ICU discharge, could be highly effective in this context. Therefore, this study was conducted to investigate the effect of midodrine on reducing the use of vasopressors in ICU patients. Methods: In this case-control study, conducted from July 1, 2023, to August 6, 2024, a total of 120 adult patients admitted to the ICU with hypotension and requiring intravenous vasopressors were included. At the beginning of the study, the target blood pressure (systolic blood pressure or mean systolic blood pressure) was determined for each patient by the treating physician during registration. Patient data was collected from their medical records in two groups: those receiving midodrine along with vasopressors and those receiving vasopressors without midodrine. The data was then analyzed. Results: Our findings demonstrated that the administration of midodrine can be highly effective in this context by accelerating the discontinuation of vasopressor medications, thereby facilitating earlier discharge from the ICU and ward. The use of midodrine was associated with a significant reduction in the duration of vasopressor therapy, which contributed to shorter ICU stays and improved overall patient outcomes. These results suggest that midodrine could play a crucial role in optimizing the management of vasopressor-dependent patients in critical care settings.