Oral midodrine treatment accelerates the liberation of intensive care unit patients from intravenous vasopressor infusions

Levine, Alexander; Meyer, Matthew J.; Bittner, Edward A.; Berg, Sheri; Kalman, Rebecca; Stanislaus, Anne B.; Ryan, Cheryl; Ball, Stephanie; Eikermann, Matthias

doi:10.1016/j.jcrc.2013.05.021

Cited by 42 publications

(67 citation statements)

References 21 publications

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“…In their study, midodrine was used predominantly in patients who had already failed IV vasopressor weaning. In addition, the midodrine doses observed in our study were twice those observed by Poveromo et al 2 Midodrine has been shown to reduce the dosage of IV vasopressors, 3 and our findings of a shortened ICU length of stay may be secondary to our unique patient population experiencing vasoplegia in septic shock and the early institution of higher doses of midodrine prior to failed or difficult weaning of IV vasopressors.…”

Section: Responsesupporting

confidence: 74%

“…2 Intuitively, the cup forceps, due to its smaller cup size, may yield smaller biopsy specimens. [3][4][5] In the present study, the size of the biopsy samples, however, did not differ between the two groups, probably because we obtained at least four moderate-to-large tissue samples in both the study groups. The complication rate was also lower with the alligator forceps, similar to that reported in a previous study.…”

Section: Responsementioning

confidence: 93%

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Whitson

Healy

et al. 2016

Chest

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Section: Responsesupporting

confidence: 74%

Section: Responsementioning

confidence: 93%

Response

Whitson

Healy

et al. 2016

Chest

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“…Midodrine increases systemic vascular resistance by directly stimulating α 1 -adrenergic receptors in arterioles and veins. 45 It undergoes enzymatic hydrolysis in the liver to form desglymidodrine, an active metabolite that ultimately exerts the medication's therapeutic effects. 44,45 Plasma levels of this metabolite peak around 1 to 2 hours after ingestion, with dosing typically recommended every 8 hours.…”

Section: Midodrinementioning

confidence: 99%

“…45 It undergoes enzymatic hydrolysis in the liver to form desglymidodrine, an active metabolite that ultimately exerts the medication's therapeutic effects. 44,45 Plasma levels of this metabolite peak around 1 to 2 hours after ingestion, with dosing typically recommended every 8 hours. A dose-dependent response in blood pressure is also seen in doses of up to 20 mg, making midodrine a desirable therapeutic agent because of its predictable pharmacokinetics.…”

Section: Midodrinementioning

confidence: 99%

Methylene Blue, Midodrine, and Pseudoephedrine

Berkel

Fuller

Alexandrov

et al. 2015

Critical Care Nursing Quarterly

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Hypotensive episodes are common among patients in the intensive care unit and can lead to multiorgan failure if uncontrolled. Fluid administration and continuous infusion of vasoactive agents are frequently used for management of hypotension; however, both therapies may be associated with adverse effects including pulmonary edema and tissue necrosis. In addition, availability of these first-line agents has been impacted by the increasing occurrence of drug shortages. Methylene blue, pseudoephedrine, and midodrine have been considered potential alternatives to standard therapy. These agents may not only be used when first-line agents are unavailable due to shortages, but they may also aid in reducing the cumulative dose of other vasoactive agents used. The purpose of this review was to discuss strategies for the safe and effective use of methylene blue, pseudoephedrine, and midodrine for the treatment of hypotension in the critically ill.

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“…Whitson and colleagues noted that the need for prolonged intravenous (IV) vasopressors might contribute to increased ICU LOS in patients with septic shock, and presented this as their rationale for investigating the potential role for oral midodrine in reducing the duration of IV vasopressor use and ICU LOS. Of note, a recent small observational trial suggested that addition of oral midodrine might accelerate IV vasopressor weaning in surgical ICU patients (18). However, this issue has not been explored in a medical ICU population.…”

mentioning

confidence: 99%

Postextubation High-Flow Nasal Cannula Oxygen, Randomized Trial of an ICU Quality Improvement Intervention, and Midodrine during Recovery from Septic Shock

Walter

Kruser

Reyfman

et al. 2017

Am J Respir Crit Care Med

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Even with careful patient selection, up to 20% of patients develop post-extubation respiratory failure and require reintubation (2). Prophylactic noninvasive positive pressure ventilation after extubation has been found to improve outcomes, including all-cause mortality, although this benefit appears restricted to patients at high risk for post-extubation respiratory failure (3) and those with chronic respiratory disorders who develop hypercapnia during a trial of spontaneous breathing (4, 5).There is increasing interest in the potential benefits of delivering humidified and heated oxygen by high-flow nasal cannula (HFNC) (6, 7). HFNC increases end-expiratory lung volume, reduces nasopharyngeal dead space, decreases work of breathing, facilitates clearance of respiratory secretions, and enhances patient comfort (8). In a recent trial, post-extubation use of HFNC in patients at high risk of post-extubation respiratory failure (identified by a Pa O 2 /FI O 2 ratio less than 300 at the end of a spontaneous breathing trial) resulted in better oxygenation than oxygen supplementation by Venturi mask and reduced the need for reintubation, although the latter was only a secondary endpoint of the study (9).The trial by Hernández and colleagues tested whether the prophylactic use of HFNC compared with conventional oxygen therapy after extubation reduced the need for reintubation in patients at low risk of post-extubation respiratory failure (1). Ten inclusion criteria were used to identify low-risk patients, including: age younger than 65 years; absence of heart failure as the primary indication for mechanical ventilation; absence of moderate to severe chronic obstructive pulmonary disease; Acute Physiology and Chronic Health Evaluation II score less than 12 on the day of extubation; body mass index less than 30 kg/m 2 ; and less than 2 comorbidities. A total of 527 subjects were ultimately enrolled in the study. Immediately after extubation, subjects were randomized to either HFNC for 24 hours (with flow uptitrated at 5 L/min intervals to the point of patient discomfort) or conventional oxygen applied through a facemask or nasal cannula. The primary outcome was need for reintubation at 72 hours. The use of HFNC significantly reduced the need for reintubation at 72 hours (4.9% vs. 12.2%; P = 0.004), with a number needed to treat of 14 to prevent 1 reintubation. Subjects treated with HFNC also had lower rates of reintubation secondary to respiratory causes (8.3% vs. 14.4%; P = 0.03).Although the results of the trial are provocative, several limitations deserve mention. Most subjects enrolled in the study had primary neurological or surgical diagnoses, whereas only a minority (16.5%) were admitted with primary respiratory failure. It was not clear that a similar benefit to HFNC would have been observed if the trial included a larger cohort of subjects with medical causes of respiratory failure. Similarly, the most common respiratory cause for reintubation with conventional oxygen therapy was the inability to clear secretion...

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Oral midodrine treatment accelerates the liberation of intensive care unit patients from intravenous vasopressor infusions

Cited by 42 publications

References 21 publications

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Methylene Blue, Midodrine, and Pseudoephedrine

Postextubation High-Flow Nasal Cannula Oxygen, Randomized Trial of an ICU Quality Improvement Intervention, and Midodrine during Recovery from Septic Shock

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