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Abstract

Existing literature evaluating the off-label use of midodrine has focused primarily on postoperative hypotensive patients requiring a single vasopressor. This study aimed to evaluate the impact of midodrine on vasopressor duration and length of stay in patients receiving vasopressors for sepsis-related hypotension. This is an institutional review board-approved, single-center, retrospective analysis of critically ill patients with hypotension secondary to sepsis who received midodrine and intravenous vasopressors compared to those who received intravenous vasopressors alone. Patients were matched by Acute Physiology and Chronic Health Evaluation II score, suspected source of infection, and presence of bacteremia. One hundred patients were included in this analysis. The median duration of vasopressors in the midodrine group (n = 50) was 36 hours (interquartile range [IQR] 18.94-61.94) compared to 26 hours (IQR 13.75-59.88) in the vasopressor-only group (P = .127). Patients in the midodrine group were in the intensive care unit (ICU) for a median of 3.9 days compared to 2.6 days in the vasopressor-only group (P = .017). Midodrine patients had a median hospital length of stay 3.7 days longer than the vasopressor-only group (P = .008). Eight patients (16%) were discharged on midodrine without an indication for therapy. This report assesses the use of midodrine in patients with sepsis requiring one or more vasopressors. Initiation of midodrine did not decrease the time to vasopressor discontinuation. The evaluation of midodrine indication and potential for its discontinuation is an intervention pharmacists can target at the transition of care from the ICU.

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