(1037) Impact of High-Dose Midodrine on Vasopressor Weaning in the Intensive Care Unit

Introduction: Midodrine, an oral α1 agonist, is often used off-label to facilitate liberation from vasopressors in patients with persistent hypotension. However, data on midodrine use in this population shows variability in outcomes and dosing strategies. This study aimed to assess the influence of high dose midodrine on vasopressor discontinuation.

Methods: A multicenter, retrospective chart review was conducted on adult ICU patients who received midodrine between May 2022 and May 2023 across 4 hospitals. This study aimed to evaluate the impact of high-dose midodrine (>60 mg/day) versus low-dose midodrine (≤60 mg/day) on time to vasopressor discontinuation from max titrated dose in ICU patients. Secondary outcomes included time to ICU discharge, total duration of vasopressors, rate of vasopressor re-initiation within 24 hours, and incidence rates of mortality, bradycardia, and hypertension.

Results: Data analysis of 79 patients in the low-dose group and 12 in the high-dose group revealed that low-dose midodrine had a greater impact on time to vasopressor discontinuation (median [IQR], 31 [12.7 - 95.6] vs 92 [33-185] h; p > 0.05). This trend was also observed in secondary outcomes, where the low-dose group showed a reduction in the total duration of vasopressor therapy (median [IQR], 5.9 [3.5 - 10.7] days vs. 11.8 [6.7 - 28.2] days; p < 0.001) and a shorter time to ICU discharge (median [IQR], 5.9 [3.5 - 10.7] days vs. 11.8 [6.7 - 28.2] days; p < 0.001). Additionally, high-dose midodrine did not lead to increased rates of bradycardia or hypertension events, as the low-dose group experienced 18 events compared to just 1 event in the high-dose group.

Conclusions: High dose midodrine (> 60 mg/day) did not decrease time to vasopressor discontinuation when compared to low dose midodrine (≤ 60 mg/day). Limitations including a small sample size and potential confounding factors warrant further investigation to validate these findings.