• Dina Hussein El Adly, Naglaa Samir Bazan, Radwa Maher El Borolossy, Islam Fawzy Anan, Mohamed Amin Fakher, and Lamia Mohamed El Wakeel.
• Critical Care Medicine Department, Cairo University Hospitals, Cairo, Egypt.
• Ir J Med Sci. 2022 Dec 1; 191 (6): 278527952785-2795.

BackgroundProlonged use of intravenous (IV) vasopressors in patients with septic shock can lead to deleterious effects.AimsThis study assessed the impact of midodrine administration on weaning off IV vasopressors and its economic value.MethodsIt is a prospective randomized controlled study of 60 resuscitated patients with septic shock who demonstrated clinical stability on low-dose IV vasopressors for at least 24 h. Participants were randomized into two groups: norepinephrine (IV norepinephrine) and midodrine (IV norepinephrine + oral midodrine 10 mg thrice a day). A cost comparison was applied based on the outcomes of both groups.ResultsThe median duration of norepinephrine administration in the midodrine and norepinephrine groups was 4 and 6 days, respectively (p = 0.001). Norepinephrine weaning time was significantly less in the midodrine versus norepinephrine groups (26 and 78.5 h, respectively; p < 0.001). Mortality was 43.3% versus 73.3% in the midodrine and norepinephrine groups, respectively (p = 0.018). The mean length of stay was comparable in the two groups. The midodrine group showed cost-saving results versus the norepinephrine group.ConclusionThe use of midodrine in septic shock patients significantly reduced IV norepinephrine duration, weaning period during the septic shock recovery phase, and mortality. Thus, the use of midodrine is dominant with less cost, better outcome and a cost-saving option in terms of budget impact analysis. This study was registered at clinicaltrials.gov (NCT 03,911,817) on April 11, 2019.© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.

17 keywords...

hide…