UMEM Educational Pearls

Category: Critical Care

Title: Oral Midodrine Use in Septic Shock

Keywords: midodrine; septic shock; vasopressors; ICU LOS (PubMed Search)

Posted: 6/8/2021 by Kim Boswell, MD
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A recent pilot study was conducted in two centers (Mayo Clinic & Cleveland Clinic Affiliate) and aimed to evaluate if the administration of oral midodrine in early septic shock could decrease the use of IV vasopressors and decrease ICU and hospital length of stay (LOS).  The study was a placebo-controlled, double blinded randomized trial.

This study enrolled:

  • 32 adult patients 
  • within 24 hours of Sepsis 3 definition who continued to have hypotension (MAP < 70mmHg) after antibiotic & 30mL/kg IVF administration
  • 3 doses of midodrine 10mg were administered

The study did not find a statistical difference between the two groups in the use of vasopressors or ICU/Hospital LOS. However, there was a trend in the midodrine group which is suggestive of decreased vasopressor use and ICU/Hospital LOS. 

It is Important to note the study was not powered to determine clinical significance. Overall the trend noted in the midodrine group should encourage further studies that are clinically powered to determine if there is a statistical difference and therefore a potential benefit to early initiation of oral midodrine in septic shock.



Lal, A, Trivedi, V, Rizvi, MS, et al. Oral Midodrine Administration During the First 24 Hours of Sepsis to Reduce the Need of Vasoactive Agents: Placebo-Controlled Feasibility Clinical Trial, Critical Care Explorations: May 2021 - Volume 3 - Issue 5 - p e0382

doi: 10.1097/CCE.0000000000000382