Should midodrine be used as an intravenous vasopressor-sparing agent in septic shock?

Simran Gupta; Ayan Sen; Aman Verma

doi:10.3949/ccjm.90a.23040

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TABLE 1

Studies of midodrine in the treatment of septic shock

Authors	Study design	Patient population	Outcomes
Lal et al⁹	Pilot, placebo-controlled, double-blind, randomized trial	Adult medical ICU patients hospitalized with sepsis; mean arterial pressure < 70 mm Hg despite sepsis treatment	Decreased duration of IVPs (P = .19) Decreased total IVP requirement (P = .59) Shorter ICU length of stay (P = .36) Similar hospital length of stay (P = .41)
Whitson et al⁷	Single-center retrospective cohort study	Patients hospitalized with septic shock requiring at least 24 hours of IVPs who demonstrated a period of clinical stability	Decreased IVP duration (P < .001) Decreased ICU length of stay (P = .017) Reduction in total IVP days and ICU patient days over year of study
Adly et al¹⁰	Single-center retrospective control study	Resuscitated patients with septic shock who demonstrated clinical stability on low-dose IVP for at least 24 hours	Reduced IVP (norepinephrine) duration (P = .001) Shorter IVP weaning period in septic shock recovery phase (P < .001) Decreased mortality (43.3% vs 73.3%, P = .018)
Santer et al¹¹	Randomized, double-blind, placebo-controlled trial	Hypotensive adult patients on single-agent IVP unable to be weaned from IVPs for at least 24 hours	No difference in time to IVP discontinuation (23.5 vs 22.5, P = .62) No difference in ICU length of stay (6 days vs 6 days, P = .46) No difference in time to ICU discharge readiness (5 days vs 5 days, P = .64) No difference in ICU readmission rate (1.5% vs 4.5%, P = .62) Increased rates of bradycardia (7.6% vs 0%)