1293: ENTERAL VASOPRESSOR USE IN CRITICALLY ILL TRAUMA PATIENTS

Abstract

Introduction: Enteral vasopressor (EV) therapies have been used to facilitate the weaning of IV vasopressors in critically ill patients. Studies have shown mixed results in the medically critically ill population; however this practice is still common. The use of EVs in the critically ill trauma population is less well described. The purpose of this medication use evaluation was to describe the use of EV therapy in our trauma and surgical ICU and to identify subpopulations which may benefit from EV therapy. Methods: This was an IRB approved single-center, retrospective medication use evaluation at a Level 1 trauma center. Inclusion criteria included: adult patients admitted from January 1st, 2020 to March 15th, 2022 to the trauma and surgical ICU; received IV continuous vasopressor(s) for more than 24 hours; and concomitant use of IV and EV(s). EV therapy was defined as midodrine and/or pseudoephedrine. The primary endpoint was overall success in weaning of IV continuous infusion vasopressors and successful weaning at < 24 hour and < 48 hour post-EV initiation. Secondary endpoints were bradycardiac events (HR < 50 bpm) and IV continuous infusion vasopressor free days in patients requiring a defined duration of vasopressor support. Results: 106 patients were included in the evaluation with 83.0% receiving midodrine and 13.2% receiving pseudoephedrine with or without midodrine. 3.8% of patients were transitioned between agents. Among the whole ICU cohort, 56.7% of patients had spinal cord injury and 54.7% had defined minimum MAP goal and duration. Overall success of IV vasopressor weaning was 78.3%. Weaning of IV vasopressors at < 24 hours and < 48 hours from EV initiation was 28.3% and 48.1%, respectfully. Bradycardia occurred in 41.5% of patients; however symptomatic bradycardia was 6.6%. Among patients with spinal cord injury and defined MAP goal duration, EV therapy was associated with a median of 3 IV vasopressor free days (interquartile range: 0-4). Conclusions: EV therapy can be used to facilitate weaning of IV vasopressor therapy in the traumatic, critically ill patients. Midodrine and pseudoephedrine use may benefit spinal cord injury patients by reducing IV vasopressor days. Future prospective studies are needed to confirm this finding.