Midodrine for the Treatment of Refractory Hypotension

Persistent hypotension in critically ill patients remains a major barrier to discharging patients from the intensive care unit (ICU). In our hospital, in patients with adequate tissue perfusion, midodrine has been observed to treat hypotension in order to wean continuous intravenous (IV) vasopressors and therefore promote ICU discharge. There are several possible etiologies of hypotension in the ICU. The most frequently seen causes include septic shock, hypovolemia, adrenal insufficiency, and idiosyncratic reactions from medications. For patients whose reversible causes of hypotension have been addressed but still require vasopressors, midodrine may prove to be a useful adjunctive medication to successfully increase blood pressure. No previous studies have examined the use of midodrine for the treatment of hypotension in an ICU setting. Therefore, we are investigating a new indication for midodrine as the treatment of hypotension in critically ill patients.

Inclusion criteria

• At least 18 years of age
• Admitted to the SICU
• Requiring IV vasopressors at a rate of less than 100 mcg/min of phenylephrine, or 8 mcg/min of norepinephrine, or 60 mcg/min of metaraminol; and unable to wean for more than 24 hours while still maintaining desired blood pressure goal

Exclusion criteria

• Inadequate tissue oxygenation
• Liver failure
• Renal failure
• Hypovolemic shock or hypotension due to adrenal insufficiency
• Pregnancy
• Severe organic heart disease
• Urinary retention
• Pheochromocytoma
• Thyrotoxicosis
• Midodrine as pre-admission medication
• Any known allergies to midodrine
• Enrollment in another clinical trial