In this episode, I’ll discuss how often midodrine use continues after a patient leaves the ICU.
Midodrine has been shown in several studies to aid in the discontinuation of vasopressors in otherwise medically stable ICU patients to facilitate discharge from the ICU. But what happens to the midodrine order after the patient leaves the ICU? There has been little focus on midodrine discontinuation in the studies that have demonstrated efficacy.
A single-center retrospective study at the Mayo Clinic in Rochester examined the incidence of midodrine continuation in ICU patients who received new midodrine for hypotension and survived to discharge.
Of the over 1000 patients given midodrine, 67% had the drug continued after ICU discharge, and 34% had midodrine continued after hospital discharge. Surprisingly, of those discharged from the ICU or hospital on midodrine, 50% were concomitantly prescribed antihypertensives. The 1 year mortality hazard ratio for this group was 1.6.
External validity of this single-center study is low but it makes sense to investigate whether this is an issue at your institution if you use midodrine for this purpose. Replicating this study locally would make for a good student or resident project!
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