title: Feasibility, Utility, and Safety of Midodrine During Recovery Phase From Septic Shock.
abstract: BACKGROUND
  We describe the feasibility, utility, and safety of oral midodrine to replace IV vasopressors during recovery from septic shock.
  
  
  METHODS
  This was a retrospective study performed in a medical ICU. All study subjects had a diagnosis of septic shock requiring at least 24 hours of IV vasopressors and demonstrated clinical stability with stable or decreasing doses of IV vasopressors. The two groups compared were those who received IV vasopressors only and those who received IV vasopressors with adjunctive midodrine.
  
  
  RESULTS
  Of the 275 study patients, 140 received an IV vasopressor only and 135 received midodrine in addition to an IV vasopressor. There was no difference between the groups' demographics (age, sex, Acute Physiology and Chronic Health Evaluation 4 score). Mean IV vasopressor duration was 3.8 days in the IV vasopressor only group and 2.9 days in the IV vasopressor with midodrine group (P < .001). An IV vasopressor was reinstituted after discontinuation in 21 of 140 (15%) patients in the IV vasopressor only group and in 7 of 135 (5.2%) patients in the IV vasopressor with midodrine group (P = .007). ICU length of stay was 9.4 days in the IV vasopressor only group and 7.5 days in the IV vasopressor with midodrine group (P = .017). There were no complications associated with midodrine use except transient bradycardia in one patient, which resolved upon discontinuation of midodrine.
  
  
  CONCLUSIONS
  Midodrine may reduce the duration of IV vasopressors during recovery phase from septic shock and may be associated with a reduction in length of stay in the ICU.
authors.affiliation: Department of Emergency/Internal/Critical Care Medicine, North Shore-LIJ Health System, New Hyde Park, NY. Electronic address: micahwhitson64@gmail.com.
authors.forename: Micah R
authors.initials: MR
authors.lastname: Whitson
authors.affiliation: Department of Emergency/Internal/Critical Care Medicine, North Shore-LIJ Health System, New Hyde Park, NY.
authors.forename: Edwin
authors.initials: E
authors.lastname: Mo
authors.affiliation: Department of Pharmacy, North Shore-LIJ Health System, New Hyde Park, NY.
authors.forename: Tasnima
authors.initials: T
authors.lastname: Nabi
authors.affiliation: Department of Pharmacy, North Shore-LIJ Health System, New Hyde Park, NY.
authors.forename: Lauren
authors.initials: L
authors.lastname: Healy
authors.affiliation: Department of Pulmonary and Critical Care Medicine, North Shore-LIJ Health System, New Hyde Park, NY.
authors.forename: Seth
authors.initials: S
authors.lastname: Koenig
authors.affiliation: Department of Pulmonary and Critical Care Medicine, North Shore-LIJ Health System, New Hyde Park, NY.
authors.forename: Mangala
authors.initials: M
authors.lastname: Narasimhan
authors.affiliation: Department of Pulmonary and Critical Care Medicine, North Shore-LIJ Health System, New Hyde Park, NY.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Mayo
mesh_terms: D000368:Aged; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D057915:Drug Substitution / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D014481:United States; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification
chemical_list: D014662:Vasoconstrictor Agents; D008879:Midodrine
keywords: critical care; hypotension; midodrine; sepsis; shock