Midodrine use in intensive care unit patients recovering from septic shock
Abstract
Background: With the rising cost of ICU care and concerns about vasopressor associated complications, clinicians need oral medications that can hasten recovery from septic shock in patients requiring low dose IV vasopressors.
Methods: We retrieved all the available studies published on PubMed and Embase (until September 2018) that reported the use of midodrine in septic shock.
Results: Levine et al reported a decrease in the intravenous vasopressor infusion rate from -0.62 ± 1.40 mcg/min per hour before midodrine to -2.20 ± 2.45 mcg/min per hour after the first four doses of midodrine (P = 0.012). Whitson et al reported a two-day decrease in mean ICU length of stay when midodrine was used with IV vasopressors (P = 0.017).
Conclusions: Midodrine may have the potential to hasten vasopressor weaning in patients recovering from septic shock, but there are limited published data available to support its use in these patients.
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References
Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 775-787.
Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017; 43:304–377.
Levy MM, Evans LE, Rhodes A, et al. The Surviving Sepsis Campaign Bundle: 2018 Update Crit Care Med 2018 Jun;46(6):997-1000.
Midodrine. Lexi-Drugs. Lexicomp. Wolters. Kluwer Health, Inc. Hudson, OH. http://online.lexi.com. Accessed May 16, 2018.
ProAmatine [package insert]. Lexington, MA: Shire US Inc; 2017.
Levine AR, Meyer MJ, Bittner EA, et al. Oral midodrine treatment accelerates the liberation of intensive care unit patients from intravenous vasopressor infusions. J Crit Care 2013;28(5):756-762.
Whitson MR, Mo E, Nabi T, et al. Feasibility, utility, and safety of midodrine during recovery phase from septic shock. Chest 2016; 149:1380–1383.
Poveromo LB, Michalets EL, Sutherland SE. Midodrine for the weaning of vasopressor infusions. J Clin PharmTherapeuti 2016; 41:260–65.
Anstey MH, Wibrow B, Thevathasan T, et al. Midodrine as adjunctive support for treatment of refractory hypotension in the intensive care unit: a multicenter randomized, placebo controlled trial (the MIDAS trial). BMC Anesthesiol 2017 Mar 21;17(1):47.
