Impact of using midodrine for vasopressor weaning in septic shock patients: a randomized controlled trial

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