Oral midodrine does not expedite liberation from protracted vasopressor infusions: A case-control study

Area of Science:

• Critical Care Medicine
• Clinical Pharmacology

Background:

• Vasopressor dependence is a frequent complication in critical illness recovery, often prolonging intensive care unit (ICU) stays and requiring interventions with inherent risks.
• Midodrine, an oral vasopressor, is frequently used off-label to facilitate the discontinuation of intravenous vasopressors and expedite ICU discharge.

Purpose of the Study:

• To evaluate the efficacy of oral midodrine in accelerating the liberation from intravenous vasopressor infusions in patients with vasopressor dependence.

Main Methods:

• A single-centre, case-control study was conducted between 2012 and 2019.
• Cases (n=19) received oral midodrine (20 mg every 8 hours), while controls (n=42) received a placebo.
• Data collected included vasopressor infusion duration and dose, hemodynamic parameters, and adverse events.

Main Results:

• Patients in the case group had a longer median duration of vasopressor infusion (94 hours) compared to controls (29.3 hours) prior to enrollment.
• Midodrine administration was not associated with a significant difference in the time to wean from intravenous vasopressors (26 hours vs. 24 hours; P=0.51).
• There was no significant difference in ICU or hospital length of stay after adjusting for confounders, and midodrine was associated with bradycardia.

Conclusions:

• Midodrine demonstrates limited efficacy in expediting the weaning process from intravenous vasopressors in patients with established vasopressor dependence, particularly those with prolonged infusion durations.
• The findings suggest that midodrine may not be an effective strategy for accelerating liberation from vasopressors in this specific patient population.