MIDODRINE as Adjunct for Septic Shock Requiring Low Dose Vasopressor in ICU

Background In septic shock requiring low dose vasopressor (norepinephrine ≤ 10 mcg/min) for more than 24 hours discharge from ICU and hospital is delayed. Midodrine an oral alpha-1 adrenergic agonist is useful in such clinical scenario. The aim of this study is to evaluate midodrine as adjunct to standard therapy for refractory septic shock in ICU. Method The study is an Interventional, prospective, and randomised control trial conducted on eighty patients in ICU. The patients were randomized into midodrine (10 mg thrice daily) and control group by simple randomization by computer generated sequence after informed consent. Discussion Midodrine was approved by FDA in 1996 for orthostatic hypotension. Due to lack of randomized control trial, the use of midodrine to taper vasopressor in ICU is still an off-label use. The results showed decreased dose and duration of vasopressor, reduced ICU LOS, and hospital LOS in midodrine group. The ICU discharge status, hospital discharge status, readmission to the ICU, and 28 days’ survival were similar in both groups. The success of oral vasopressor midodrine reduces cost of ICU treatment and increases ICU bed availability in limited health infrastructure like ours.