This study proved the feasibility of clinical trial to use oral midodrine in early sepsis. The study was not powered to detect statistically significant differences between the two groups, and therefore, the results from our study did not reach the level of statistical significance.

However, a consistent trend was noted toward shorter duration of IV vasopressor requirement, shorter ICU LOS, better lactic acid clearance, and lower vasopressor (NEE) requirement overall in the first 24 hours of ICU stay for patients admitted with sepsis.

Midodrine hydrochloride has been studied in the recovery phase of shock to reduce the need for IV vasopressors through its action on alpha-1 receptors.

It was found to reduce the need for IV vasoactive agents during the recovery phase of shock without increasing the risk for complications. Data from an observational study also support the hypothesis that the use of midodrine hydrochloride in the surgical ICU setting is associated with reduced ICU LOS and early liberation from IV vasopressors.

Our study findings corroborate the hypothesis generated by the above studies. However, the design of our study had the advantage of introducing therapy in the early phase of sepsis rather than the recovery phase, thereby shortening the stay in the ICU.

This study also demonstrated that midodrine hydrochloride can reduce the need for IV vasoactive agents in the early phase of sepsis rather than the recovery phase of shock.

The prospective design of the study and blinded randomization also negated the disadvantages of allocation and selection bias. It also minimized the statistical unreliability from confounding factors.

Read More