背景:持续的血管加压药需求是重症监护病房(ICU)延迟释放的常见原因,有时使用辅助口服药物来加快血管加压药停药的时间。我们试图描述屈昔多巴在长期低血压的危重患者中用于血管加压药撤机的用途。
方法:本回顾性研究,单臂,观察性研究包括2016年06月至2023年07月在两个学术中心入住ICU的成年患者,这些患者接受了屈昔多巴用于血管加压药断奶.入院前接受屈昔多巴或其他适应症的患者被排除在外。主要结果是升压药停药时间,定义为当血管加压药停止并保持关闭至少24小时。次要结局包括心动过速和开始后低血压的发生率,去甲肾上腺素等效物开始前和开始后,同时使用口服药物,和剂量。对通过饲管接受屈昔多巴的患者进行了亚组分析。
结果:共有30例患者符合纳入标准。中位年龄为62岁,12人(40%)为女性,73%在心脏/心脏外科ICU。在屈昔多巴开始之前,患者服用血管加压药的中位数为16天。升压药停药的中位时间(IQR)为70小时(23-192),去甲肾上腺素当量在开始后立即降低(0.08vs0.02mcg/kg/min,p<0.001)。屈昔多巴开始后MAP增加(68.8vs66.5mmHg,p=0.008),而心率不变(86vs84BPM,开始后p=0.37)。在屈昔多巴启动后72小时内与超过72小时断奶的患者更有可能在启动前服用较低的去甲肾上腺素当量(0.05vs0.12mcg/kg/min,p=0.013)。饲管给药不影响血管加压药停药的时间(p=0.93)。
结论:Droxidopa可被视为血管加压药断奶的辅助治疗。在分析通过饲管接受屈昔多巴的患者时,效果相似。
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.
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.