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Droxidopa or Atomoxetine for Refractory Hypotension in Critically Ill Cardiothoracic Surgery Patients.

Publication ,  Journal Article
Lessing, JK; Kram, SJ; Levy, JH; Grecu, LM; Katz, JN
Published in: J Cardiothorac Vasc Anesth
January 2024

OBJECTIVE: To evaluate the effects of droxidopa or atomoxetine on intravenous (IV) vasoactive agent discontinuation in cardiothoracic intensive care unit (ICU) patients with hypotension refractory to midodrine. DESIGN: Single-center, retrospective cohort study. SETTING: Tertiary- and quaternary-care university teaching hospital. PARTICIPANTS: Included patients who received at least 4 consecutive doses of droxidopa or atomoxetine and remained on concurrent midodrine. Patients were excluded if they received study medication before admission, had clinical deterioration after study medication initiation requiring additional vasoactives/escalation of IV vasoactive dosage for at least 12 hours, had a diagnosis of hepatorenal syndrome, were prisoners, or were pregnant. INTERVENTIONS: Droxidopa, atomoxetine, or both. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was time to discontinuation of IV vasoactive agents after initiation of study medication, analyzed using a Kaplan-Meier estimate with the Wilcoxon method, censoring death within 24 hours of the last dose of study medication. No adjustment for repetitive analyses was made, as the analysis was hypothesis-generating. Of the 72 charts reviewed, 45 patients met inclusion criteria (18 atomoxetine, 17 droxidopa, and 10 both). There were no differences in median time to discontinuation of IV vasoactive agents (21.9 days v 8.0 days v 13.9 days, respectively; p = 0.259) or ICU or hospital length of stay between groups. A higher percentage of patients who survived to hospital discharge received both study medications or droxidopa alone (90% v 76.5%) than atomoxetine alone (44.4%, p = 0.028). CONCLUSIONS: Droxidopa and atomoxetine are oral vasoactive agents with potential mechanisms to facilitate IV vasopressor weaning for patients in the ICU with hypotension refractory to midodrine, but further prospective research is needed.

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Published In

J Cardiothorac Vasc Anesth

DOI

EISSN

1532-8422

Publication Date

January 2024

Volume

38

Issue

1

Start / End Page

155 / 161

Location

United States

Related Subject Headings

  • Vasoconstrictor Agents
  • Retrospective Studies
  • Midodrine
  • Hypotension
  • Humans
  • Droxidopa
  • Critical Illness
  • Atomoxetine Hydrochloride
  • Anesthesiology
  • 3201 Cardiovascular medicine and haematology
 

Citation

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Lessing, J. K., Kram, S. J., Levy, J. H., Grecu, L. M., & Katz, J. N. (2024). Droxidopa or Atomoxetine for Refractory Hypotension in Critically Ill Cardiothoracic Surgery Patients. J Cardiothorac Vasc Anesth, 38(1), 155–161. https://doi.org/10.1053/j.jvca.2023.09.023
Lessing, Julia K., Shawn J. Kram, Jerrold H. Levy, Loreta M. Grecu, and Jason N. Katz. “Droxidopa or Atomoxetine for Refractory Hypotension in Critically Ill Cardiothoracic Surgery Patients.J Cardiothorac Vasc Anesth 38, no. 1 (January 2024): 155–61. https://doi.org/10.1053/j.jvca.2023.09.023.
Lessing JK, Kram SJ, Levy JH, Grecu LM, Katz JN. Droxidopa or Atomoxetine for Refractory Hypotension in Critically Ill Cardiothoracic Surgery Patients. J Cardiothorac Vasc Anesth. 2024 Jan;38(1):155–61.
Lessing, Julia K., et al. “Droxidopa or Atomoxetine for Refractory Hypotension in Critically Ill Cardiothoracic Surgery Patients.J Cardiothorac Vasc Anesth, vol. 38, no. 1, Jan. 2024, pp. 155–61. Pubmed, doi:10.1053/j.jvca.2023.09.023.
Lessing JK, Kram SJ, Levy JH, Grecu LM, Katz JN. Droxidopa or Atomoxetine for Refractory Hypotension in Critically Ill Cardiothoracic Surgery Patients. J Cardiothorac Vasc Anesth. 2024 Jan;38(1):155–161.
Journal cover image

Published In

J Cardiothorac Vasc Anesth

DOI

EISSN

1532-8422

Publication Date

January 2024

Volume

38

Issue

1

Start / End Page

155 / 161

Location

United States

Related Subject Headings

  • Vasoconstrictor Agents
  • Retrospective Studies
  • Midodrine
  • Hypotension
  • Humans
  • Droxidopa
  • Critical Illness
  • Atomoxetine Hydrochloride
  • Anesthesiology
  • 3201 Cardiovascular medicine and haematology