(精选)Oral Midodrine to Wean off Intravenous Vasopressors in the Intensive Care Unit教学课件.pptVIP

Oral Midodrine to Wean off Intravenous Vasopressors in the Intensive Care Unit Linda Kamakuru, Pharm.D. PGY1 Pharmacy Resident WellStar Kennestone Hospital Marietta, Georgia linda.kamakuru@wellstar.org * * Disclosure Statement Disclosure statement: These individuals have the following to disclose concerning possible financial or personal relationship with commercial entities (or their competitors) that may be referenced in this presentation. Resident: Linda Kamakuru (nothing to disclose) Project advisors: Sylvia Best, Joy Peterson, Asif Saberi, Kathleen Jerguson (nothing to disclose) WellStar Health System (WHS) 11 facility system WellStar Kennestone 633 beds tertiary hospital 77 ICU beds Level II trauma center Located northwest of Atlanta WellStar Cobb 382 beds hospital Located northwest of Atlanta * Background Vasopressors are cornerstone therapy in fluid unresponsive shock Caveat: Must be administered only in the intensive care unit (ICU) Increase ICU length of stay (LOS) Increase risk for ICU complications Predisposition to adverse effects associated with vasopressor use Should be weaned off as early as possible once hemodynamic stability is achieved * Background: Weaning Vasopressors * Adapted from Advances in sepsis. 2007: 6 (2); 34-40. Increase Norepinephrine Hemodynamic monitoring parameters Central venous pressure (CVP) Mean arterial pressure (MAP) Mixed venous oxygen saturation (SvO2) Stroke volume variation (SVV) Background: Emerging Practice * Midodrine may be a possible adjunctive therapy to wean off vasopressors in shock Oral midodrine treatment and IV vasopressor infusion Oral midodrine treatment and IV vasopressor infusion Whitson et al. CHEST, 2016. Levine et al. Journal of Critical Care, 2013. P = .012 Outcome Variables Variables IV vasopressor only (n=135) IV vasopressor with midodrine (n=135) p-value IV vasopressor duration (days) 3.8 2.9 0.001 IV vasopressor reinst