Using midodrine to accelerate weaning of intravenous vasopressors in acute spinal cord injured patients admitted to the intensive care unit: A retrospective study of 28 patients.

Study Design: A retrospective study with a crossover design.

Objectives: Maintaining mean arterial pressure (MAP) is crucial in the early management of SCI, yet the role of oral midodrine in this setting remains unclear. This study evaluates whether midodrine facilitates IV vasopressor weaning within 24 hours of initiation.

Setting: The study was conducted at a Level 1 trauma center.

Methods: A cohort of 28 patients was analyzed. MAP levels and IV vasopressor dosages were recorded 24 hours before and after midodrine initiation. The primary outcome was reduced IV vasopressor use while maintaining MAP targets.

Results: Midodrine was started on average 4.0±1.9 days after initiation of intravenous vasopressor therapy. Twenty-two individuals (78.6%) received less intravenous vasopressors during the 24-hour period after initiation of midodrine. Mean MAP remained similar 24 hours before vs. after initiation of midodrine (90.4±3.3 vs. 88.6±5.1 mm Hg). Earlier introduction of midodrine was significantly related to more rapid weaning and reduced total duration of intravenous vasopressor therapy.

Conclusions: Initiating oral midodrine in the ICU within 7 days of a traumatic SCI resulted in a rapid decrease in intravenous vasopressor requirements in close to 80% of people while maintaining MAP targets, therefore supporting the potential of midodrine to accelerate the weaning of intravenous vasopressors.