Enteral Midodrine for Intravenous Vasopressor Weaning in Acute Traumatic Spinal Cord Injury Patients

Hospital Pharmacy, 2024 · DOI: 10.1177/00185787241306278 · Published: January 1, 2024

Simple Explanation

This study investigates the use of enteral midodrine, an oral medication, to help wean patients with acute traumatic spinal cord injuries off intravenous (IV) vasopressors, which are drugs used to maintain blood pressure. IV vasopressors are resource-intensive. The study found that midodrine was associated with successful weaning from IV vasopressors in a significant percentage of patients. This suggests that midodrine could be a useful tool in reducing the need for IV vasopressors in this patient population. However, the study also noted a high incidence of bradycardia (slow heart rate) among patients receiving midodrine, although most cases did not require treatment. This highlights the need for careful monitoring when using midodrine in this setting.

Study Duration

January 1st, 2020 to March 15th, 2022

Participants

48 adult patients admitted to the trauma and surgical ICU for acute traumatic spinal cord injury

Evidence Level

Retrospective review

Key Findings

1
79.2% of patients successfully weaned off IV vasopressors after the addition of midodrine.
2
22.9% and 43.8% discontinued IV vasopressors at <24 and <48 hours, respectively, after midodrine initiation.
3
Midodrine was associated with a median of 3 IV vasopressor-free days in patients with a defined MAP goal duration.

Research Summary

This retrospective study evaluated the efficacy and safety of enteral midodrine in facilitating the weaning of IV vasopressors in acute traumatic spinal cord injury patients. The study found that midodrine was associated with a high rate of successful IV vasopressor discontinuation. The use of midodrine also resulted in a reduction of IV vasopressor days in patients with MAP augmentation goals. However, bradycardia was a common side effect, although rarely requiring treatment. The authors conclude that enteral midodrine may be a beneficial adjunct to IV vasopressors in this patient population and suggest that future prospective studies are needed to confirm these findings.

Practical Implications

Reduced ICU Resource Utilization

The successful weaning of IV vasopressors using enteral midodrine may lead to decreased ICU stay and associated healthcare costs.

Improved Patient Outcomes

Sparing IV vasopressor days may reduce the risk of complications associated with prolonged IV access and vasopressor use.

Guidance for Clinical Practice

The study provides evidence supporting the use of midodrine as an adjunct therapy in acute traumatic spinal cord injury patients requiring hemodynamic support.

Study Limitations

1
Retrospective study design introduces potential selection bias.
2
Lack of a control group limits the ability to definitively determine the efficacy of midodrine.
3
The non-protocolized midodrine starting doses and titration.

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