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- W4313232818 abstract "Introduction: Intravenous vasopressors, notably norepinephrine, are used to maintain mean arterial pressure ≥65 mmHg in septic shock. Midodrine, an oral alpha-1 agonist, has adjunctive potential in aiding with vasopressor dose reduction and discontinuation. Studies investigating midodrine as a vasopressor sparing agent have demonstrated conflicting results. The purpose of this study is to assess the effect of midodrine on time to intravenous vasopressor discontinuation in patients with septic shock receiving higher doses of norepinephrine than previously studied. Methods: A retrospective analysis was conducted of adult patients admitted to the intensive care unit (ICU) at Broward Health hospitals from June 1, 2017 to October 31, 2021 with a diagnosis of septic shock. Subjects that received norepinephrine ≥0.2 mcg/kg/min for ≥24 hours and not meeting exclusion criteria were divided into midodrine adjunctive arm or control group based on receipt of at least three doses of midodrine. Results: 139 patients were included in this analysis and had similar baseline characteristics with the exception of patients who did not receive midodrine being significantly younger (58.1 vs 67 years p=0.003). The primary outcome of time to norepinephrine discontinuation was significantly longer in the midodrine group compared with subjects that did not receive midodrine (96 hours vs 75 hours p=0.01). When controlled for patients who discontinued norepinephrine due to mortality or hospice admission, this increased time to norepinephrine discontinuation in the midodrine group no longer retained statistical significance (92 hours vs 74 hours p=0.07). A significant reduction in norepinephrine dose was associated with the addition of midodrine (0.21 mcg/kg/min vs 0.24 mcg/kg/min p=0.03). No other statistically significant differences in secondary outcomes were seen. Conclusions: In patients with septic shock requiring norepinephrine ≥0.2 mcg/kg/min for ≥24 hours, the addition of midodrine was associated with an increased time to norepinephrine discontinuation by about one day. This result was no longer significant when patients who discontinued norepinephrine due to mortality or hospice admission were censored." @default.
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- W4313232818 date "2022-12-15" @default.
- W4313232818 modified "2023-10-18" @default.
- W4313232818 title "1181: EFFICACY AND SAFETY OF MIDODRINE AS ADJUNCTIVE THERAPY WITH NOREPINEPHRINE IN SEPTIC SHOCK PATIENTS" @default.
- W4313232818 doi "https://doi.org/10.1097/01.ccm.0000910460.51221.5b" @default.
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