Key result
Midodrine significantly increased mean arterial pressure upon discontinuation of intravenous vasopressors (73.11 vs 70.29 mmHg, P<0.001) and reduced norepinephrine duration in septic shock patients.
Why the study?
Weaning off intravenous vasopressors in sepsis and septic shock can be problematic, prompting an assessment of whether midodrine administration facilitates weaning.
Does midodrine improve mean arterial pressure and reduce vasopressor duration in adult patients with septic shock?
RCT (n=150)
Open-label
Computer-generated randomization numbers
No
Does midodrine improve mean arterial pressure and reduce vasopressor duration in adult patients with septic shock?
Absolute Event Rate: 73.11% vs 70.29%
p-value: p=<0.001
Midodrine effectively increases mean arterial pressure and reduces the duration of intravenous norepinephrine use in patients with septic shock, though it does not significantly impact ICU or hospital length of stay.
Midodrine shortens IV norepinephrine duration in septic shock; extends RCT evidence on weaning without affecting stay or mortality.
Background & objective: Sepsis and septic shock are almost always associated with severe hypotension. Various vasopressors are being used to treat hypotension. Sometimes process of weaning off intravenous (IV) vasopressors becomes really problematic. We assessed the effect of midodrine administration to facilitate weaning. Methodology: This randomized controlled trial involved 150 patients, eighteen years of age or older, both sexes, who required a vasopressor for a period exceeding 24 hours due to septic shock. Randomly, patients were assigned to one of the two groups: Group M received midodrine 10 mg orally or by the Ryle’s tube every 8 hours; Group C did not receive midodrine. Results: The mean arterial blood pressure (MAP) of both groups did not exhibit a significant difference when IV vasopressors were initiated and were markedly increased in Group M compared to Group C when IV vasopressors were discontinued (P < 0.001). The MAP percentage change was substantially increased in Group M compared to Group C (42.33 ± 22.01 vs 31.16 ± 17.36, P < 0.001). The number of IV vasopressors used was comparable between both groups. The duration of IV norepinephrine use was notably reduced in Group M than in Group C (P = 0.003). ICU duration, hospital stay, and hospital mortality differed insignificantly between the two groups. Conclusion: Midodrine effectively increases blood pressure and reduces IV norepinephrine use, while ICU stay, hospital stay, and the hospital mortality were comparable in both groups in septic shock patients. Abbreviations: APACHE: Acute Physiology and Chronic Health Evaluation, FDA: Food and Drug Administration, ICU: intensive care unit, IVV: Intravenous vasopressors, LOS: length of stay, MAP: mean arterial pressure Keywords: Midodrine; Vasopressor; Septic shock; Intensive Care Unit Citation: Mahmoud MA, Osman HAM, Hamed KAE. Impact of using midodrine for vasopressor weaning in septic shock patients: a randomized controlled trial. Anaesth. pain intensive care 2025;29(3):520-526. DOI: 10.35975/apic.v29i3.2752 Received: October 15, 2024; Revised: February 26, 2025; Accepted: March 24, 2025
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Mahmoud et al. (2025) conducted an RCT in Septic shock (n=150). Midodrine vs. No midodrine was evaluated on Mean arterial pressure (MAP) when IV vasopressors were discontinued (p=<0.001). Midodrine significantly increased mean arterial pressure upon discontinuation of intravenous vasopressors (73.11 vs 70.29 mmHg, P<0.001) and reduced norepinephrine duration in septic shock patients.
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