Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Critical Care Medicine

Background: Patients admitted to intensive care units (ICU) are often treated with intravenous (IV) vasopressors. Persistent hypotension and dependence on IV vasopressors in otherwise resuscitated patients lead to delay in discharge from ICU. Midodrine is an oral alpha-1 adrenergic agonist approved for treatment of symptomatic orthostatic hypotension. The use of midodrine as a vasopressor sparing agent has steadily increased in the ICU despite limited evidence for this off label use. Objectives: To evaluate the role of midodrine in weaning of vasopressor infusions in patient admitted to ICU with septic shock, and to evaluate of the effect of midodrine on outcome of septic patients regarding length of ICU stay and ICU mortality. Patients and Methods: This study was a randomized controlled intervention trial, being conducted in the critical care department, Kasr Elainy hospital, Cairo university, Cairo, Egypt. We targeted 60 patients. Adult patients aged {u2265}18 years, admitted to the ICU with diagnosis of septic shock and who were on IV vasopressors for at least 24 h were considered for recruitment. Participants were randomized to either receive midodrine, 10 mg three times a day, or not in addition to standard care. The primary outcome is the time (hours) from initiation to discontinuation of IV vasopressors and duration of weaning. Secondary outcomes include ICU LOS (days), ICU mortality rate. Results: The IV vasopressor duration (hours) and IV vasopressor weaning duration (hours) were lower in the midodrine group when compared to IV vasopressor only group but the difference is statistically insignificant (139.03±46.95 VS 141.90±79.77 and 62.37±14.94 VS 74.20±36.78 respectively). MAP was significantly improved in midodrine group from 84.50 mmHg at the time of midodrine initiation to 88.03 mmHg after 24hours of midodrine initiation (p=0.04) No differences in secondary outcomes, including ICU length of stay and ICU mortality, were observed

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