Midodrine as Adjunction Support for Weaning off Norepinephrine in Septic Shock
Hussien Gamal Mohammed Hafez, Sherif Wadie Nashed, Fady Adib Abd El Malek Morkos, Wael Abd El_Moneim Mohamed Abd El Wahab- General Medicine
Abstract
Background
Septic shock is the most severe form of sepsis, in which profound underlying abnormalities in circulatory and cellular/metabolic parameters lead to substantially increased mortality.
Objective
To evaluate whether oral administration of midodrine is an effective adjunct to standard therapy to reduce the duration of IV norepinephrine and allow earlier discharge from ICU compared to control patients.
Patients and Methods
This was a Prospective comparative study. The population of the study included 60 patients whom were admitted to adult ICU department with septic shock. This study was included 60 critically ill patients who was fulfilled the diagnostic criteria for septic shock were randomly assigned to one of two group each one was included 30 patients.
Results
Concerning the effect of midodrine on the outcome of septic patients, our study showed that there was highly significant effect on the ICU length of stay and ICU mortality. (The ICU length of stay (days) in midodrine group = 6.2 VS 8.3 in control group (p = less than 0.001) and the ICU survival in midodrine group = 96.7%VS 60% in control group (p = 0.001). A number of confounding factors may have influenced this endpoint, including the provider confidence in patient stability, bed availability on floor or step-down units or continued need for ICU monitoring for other reasons.
Conclusion
Use of midodrine significantly reduces duration of IV vasopressor infusion during the recovery phase of septic shock. Use of midodrine has great impact on overall survival, length of ICU stay and ICU survival. Administration of midodrine improved MAP & serum lactate in midodrine group.