Use of oral midodrine for weaning off norepinephrine in patients with septic shock

Abstract

Background
Early administration of norepinephrine in septic shock patients is linked to better survival rates. However, vasopressor dependence often occurs during the recovery phase, delaying ICU discharge.


Objectives
A comparative study was conducted on patients admitted with a diagnosis of septic shock over 2 years regarding the use of oral midodrine in weaning them off norepinephrine.


Patients and methods
The population in this study included 100 patients admitted to the adult ICU department with septic shock between October 2016 and August 2018. Participants were divided into two cohorts: Group I was administered only IV norepinephrine, whereas Group II was given both IV norepinephrine and midodrine. Participants in the midodrine group were administered 10 mg of midodrine orally every 8 h.


Results
Results showed that patients not receiving oral midodrine had higher NE doses, longer NE infusion duration, extended NE weaning time, and increased ICU and hospital stay compared to those who did receive oral midodrine (p < 0.001). Our study indicates that oral midodrine was not a predictor of survival rate (p = 0.964).


Conclusions
Midodrine may serve as a valuable adjunct for weaning from IV vasopressors in septic shock patients. Septic shock patients who received midodrine for IV norepinephrine weaning showed significantly lower NE doses, durations of NE infusion, and NE weaning times.