(1475) Midodrine in Early Septic Shock

Introduction: Septic shock is a leading cause of mortality in the intensive care unit (ICU) with a 30% mortality rate. Prolonged use of vasopressors can be associated with tissue necrosis, dysrhythmias, and bowel ischemia. Several studies have evaluated the use of midodrine, an oral vasoconstrictive agent, in the recovery phase of septic shock; however, there is a lack of data assessing midodrine use in the early stages of septic shock. Midodrine may serve as an agent to minimize the initiation or prolonged use of continuous intravenous vasopressors, central venous catheters, and ICU and hospital length of stay.

Methods: This was a retrospective cohort study evaluating adult patients diagnosed with septic shock, who received treatment with resuscitative fluids and antibiotic therapy, and then received further management with either midodrine or vasopressor therapy. The primary outcome was vasopressor duration of use. Secondary outcomes included ICU and hospital length of stay, 28-day and in-hospital mortality, shock progression, and ventilator days.

Results: 182 patients (95 midodrine, 87 norepinephrine) were included in the study with significantly more male and mechanically ventilated patients in the midodrine group, and a higher SOFA score reported in the norepinephrine group (6 vs. 5, p< 0.0001). No significant difference was noted in the primary outcome, although shock progression was more likely in the norepinephrine group (68% vs. 34%, p< 0.0001). Additionally, although a trend towards reduced 28-day mortality (39% vs. 27%, p=0.1147) and in-hospital mortality (43% vs. 29%, p=0.882) was noted in the midodrine group, a statistically significant difference was not seen. Lastly, hospital length of stay was significantly shorter in the midodrine group (381 vs. 288 hours, p=0.0075), with ICU length of stay being almost two days shorter (230 vs. 192 hours, p=0.1719).

Conclusions: Based on results of this study, patients in the early stages of septic shock initially receiving midodrine rather than norepinephrine showed promising results with shock progression and hospital length of stay. Further randomized clinical trials are needed to validate results of this study and assess the potential benefit of midodrine use in early septic shock.