Using of Oral Midodrine in Weaning of Intravenous Vasopressors in Patients with Septic Shock Admitted to ICU

Abstract

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. Diagnosis of septic shock is based on presence of certain symtoms, signs & there is also many Biomarkers which are essential for Diagnosis and Prognosis of Sepsis patients like CRP, Prolactin & BNP. Objective To assess whether the use of adjunctive oral midodrine in patients with vasopressordependent hypotension reduces the time to cessation of intravenous vasopressor. Patients and Methods In order to achieve this aim, we included a total of 140 patients admitted to the ICU unit at Ain Shams University Hospitals who developed septic shock and required IV vasopressors. Patients were divided into 2 groups: Group (A): consists of 70 patients who will receive IV vasopressors only (control group). Group (B): consists of 70 patients who will receive IV vasopressors with adjunctive oral midodrine (midodrine group) or (case group). Results In our study there were no significant differences among patient’s demographics, clinical and hemodynamic parameters suggesting so that the observed results were not secondary to baseline group characteristics. Our results indicate that use of oral midodrine during recovery from septic shock has no effect on the duration and weaning of IV vasopressor infusions. Although the previous parameters were lower in the IV vasopressor with midodrine group compared with the IV vasopressor only group, but the differences weren't significant. The IV vasopressor duration in hours was (139.65 ± 46.21 VS 141.30 ± 79.00) and the IV vasopressor weaning duration in hours was (65.37 ± 13.94 VS 73.20 ± 35.78). These insignificant results may be attributed to the absence of special protocol for vasopressor weaning in the unit, in addition to the obligatory and temporary stoppage of vasopressor weaning when hemodynamic instability occurs (MAP ≤65 mmHg or SBP < 90 mmHg, low urine output < 0.5 ml/kg/h). Our results are inconsistent with most of studies that have demonstrated that midodrine use was associated with a rapid and effective wean from IV vasopressors. Conclusion Use of midodrine doesn't reduce duration of IV vasopressor infusion and weaning during the recovery phase of septic shock. Use of midodrine has no impact on overall survival, length of ICU stay and ICU mortality. Administration of midodrine improved MAP in midodrine group.