Droxidopa for Vasopressor Weaning in Critically Ill Patients with Persistent Hypotension: A Multicenter,...

Area of Science:

• Critical Care Medicine
• Pharmacology

Background:

• Prolonged vasopressor use is a common cause of delayed intensive care unit (ICU) liberation.
• Adjunct oral agents are explored to expedite vasopressor discontinuation.

Purpose of the Study:

• To describe the use of droxidopa for vasopressor weaning in critically ill patients experiencing prolonged hypotension.
• To evaluate the efficacy and safety of droxidopa in this patient population.

Main Methods:

• Retrospective, single-arm, observational study at two academic centers (06/2016-07/2023).
• Included adult ICU patients receiving droxidopa for vasopressor weaning; excluded those with prior use or other indications.
• Primary outcome: time to vasopressor discontinuation (off for ≥24 hours).

Main Results:

• 30 patients met criteria; median age 62, 73% in cardiac/cardiac surgical ICUs.
• Median time to vasopressor discontinuation was 70 hours.
• Norepinephrine equivalents decreased (0.08 to 0.02 mcg/kg/min, p<0.001) and MAP increased (p=0.008) post-initiation; heart rates unchanged (p=0.37).
• Lower baseline norepinephrine use predicted faster weaning (<72 hours).
• Feeding tube administration did not affect time to discontinuation (p=0.93).

Conclusions:

• Droxidopa may serve as an effective adjunct therapy for vasopressor weaning in critically ill patients.
• The route of administration (oral vs. feeding tube) did not significantly alter outcomes.