Droxidopa for Vasopressor Weaning in Critically Ill Patients with Persistent Hypotension: A Multicenter, Retrospective, Single-Arm Observational Study.

Autor:	Webb AJ; Department of Pharmacy, Massachusetts General Hospital, Boston, USA., Casal GL; Department of Pharmacy, Massachusetts General Hospital, Boston, USA., Newman KA; Department of Pharmacy, Massachusetts General Hospital, Boston, USA., Culshaw JR; Department of Pharmacy, Brigham and Women's Hospital, Boston, USA., Northam KA; Department of Pharmacy, Massachusetts General Hospital, Boston, USA., Solomon EJ; Department of Pharmacy, Massachusetts General Hospital, Boston, USA., Beargie SM; Department of Pharmacy, Massachusetts General Hospital, Boston, USA., Johnson RB; Department of Pharmacy, Massachusetts General Hospital, Boston, USA., Lopez ND; Department of Pharmacy, Massachusetts General Hospital, Boston, USA., Hayes BD; Department of Pharmacy, Massachusetts General Hospital, Boston, USA.; Department of Emergency Medicine, Harvard Medical School, Boston, USA., Roberts RJ; Department of Pharmacy, Massachusetts General Hospital, Boston, USA.
Jazyk:	angličtina
Zdroj:	Journal of intensive care medicine [J Intensive Care Med] 2024 Aug 07, pp. 8850666241270089. Date of Electronic Publication: 2024 Aug 07.
DOI:	10.1177/08850666241270089
Abstrakt:	Background: Persistent vasopressor requirements are a common reason for delayed liberation from the intensive care unit (ICU) and adjunct oral agents are sometimes used to hasten time to vasopressor discontinuation. We sought to describe the use of droxidopa for vasopressor weaning in critically ill patients with prolonged hypotension. Materials and Methods: This retrospective, single-arm, observational study included adult patients admitted to an ICU at two academic centers between 06/2016-07/2023 who received droxidopa for vasopressor weaning. Patients who received droxidopa prior to admission or for another indication were excluded. The primary outcome was time to vasopressor discontinuation, defined as when vasopressors were stopped and remained off for at least 24 h. Secondary outcomes included rates of tachycardia and hypotension post-initiation, norepinephrine equivalents pre- and post-initiation, concomitant oral agent use, and dosing. A subgroup analysis was conducted in patients receiving droxidopa via feeding tubes. Results: A total of 30 patients met inclusion criteria. Median age was 62 years old, 12 (40%) were female, and 73% were in a cardiac/cardiac surgical ICU. Patients were on vasopressors for a median of 16 days prior to droxidopa initiation. Median (IQR) time to vasopressor discontinuation was 70 h (23-192) and norepinephrine equivalents decreased immediately after initiation (0.08 vs 0.02 mcg/kg/min, p < 0.001). MAP increased after droxidopa initiation (68.8 vs 66.5 mm Hg, p = 0.008) while heart rates were unchanged (86 vs 84 BPM, p = 0.37) after initiation. Patients who weaned from vasopressors within 72 h versus longer than 72 h after droxidopa initiation were more likely to be on lower norepinephrine equivalents prior to initiation (0.05 vs 0.12 mcg/kg/min, p = 0.013). Feeding tube administration did not impact time to vasopressor discontinuation (p = 0.93). Conclusions: Droxidopa may be considered an adjunct therapy for vasopressor weaning. Effects were similar when analyzing patients receiving droxidopa via feeding tube.
Databáze:	MEDLINE
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