• Rahul Costa-Pinto, Zhen-Ti Yong, Fumitaka Yanase, Chelsea Young, Alastair Brown, Andrew Udy, Paul J Young, Glenn Eastwood, and Rinaldo Bellomo.
• Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia; Department of Critical Care, Department of Medicine, the University of Melbourne, Parkville, Victoria, Australia. Electronic address: rahul.costa-pinto@austin.org.au.
• J Crit Care. 2022 Feb 1; 67: 166171166-171.

PurposeTo assess the feasibility and physiological efficacy of adjunctive midodrine in patients with vasopressor-dependent hypotension.Materials And MethodsThis was a pilot, open label, randomised controlled trial. Patients were enrolled from two tertiary intensive care units on low dose intravenous vasopressor therapy for more than 24 h. We randomly assigned patients to receive either adjunctive midodrine (10 mg every 8 h) or usual care. The primary efficacy outcome was time to cessation of intravenous vasopressor therapy. Secondary outcomes included protocol compliance, ICU and hospital length of stay.ResultsWe screened 381 patients over 22-months and enrolled 62 (32 in midodrine group, 30 in usual care group). Median time to cessation of vasopressor infusion was 16.5 h for midodrine vs 19 h for usual care (p = 0.22). Time in ICU (50 [25.50, 74.00] hours for midodrine v 59 [38.50, 93.25] hours for usual care, p = 0.14) and hospital length of stay (9 days vs. 7.5 days, p = 0.92) were similar. Protocol compliance was 96.9%. One patient ceased midodrine early due to symptomatic bradycardia.ConclusionsAdjunctive midodrine therapy was feasible with acceptable compliance, duration of therapy, and safety profile. However, at the chosen dose, there was no evidence of physiological or clinical efficacy.Copyright © 2021 Elsevier Inc. All rights reserved.

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