Effect of midodrine in covid-19 patients with septic shock on time to vasopressor discontinuation

Introduction: Patients with COVID-19 in the intensive care unit (ICU) often require prolonged use of intravenous (IV) vasopressors which become a barrier to intensive care unit (ICU) discharge. The goal of this study is to describe the effect of midodrine, an alpha-1 agonist, on time to IV vasopressor discontinuation in COVID-19 patients in the ICU. Methods: This study was an IRB-approved retrospective chart review conducted at a community, tertiary care hospital between January 2020 until November 2021. Eligible participants included hypotensive patients aged 18 years or older who were admitted to an ICU on at least 0.1 mcg/kg/min of norepinephrine for 24hrs with a diagnosis of septic shock and COVID-19. Pearson Chi-Square and Independent-Samples Mann-Whitney U Test were used to analyze baseline characteristics, ICU length of stay, and time to IV vasopressor discontinuation in patients that received at least one dose of midodrine and patients on comparable IV vasopressors not started on midodrine. Results: 70 patients were included in the study with 35 patients in the midodrine group and 35 patients in the control group. The median time to IV vasopressor discontinuation was 13 days for the midodrine group and 8 days for the control group (p < 0.001), but there were less patients started on a second IV vasopressor in the midodrine group. Median time of initiation of midodrine was 9 days and IV vasopressors were discontinued at a median of 4 days after starting midodrine. The mean ICU length of stay and Hospital length of stay were 26 days & 32 days in the midodrine group and 15 days & 21 days in the control group (p < 0.001). The average dose of midodrine was 10 mg per day. Conclusions: The initiation of midodrine in COVID-19 patients with septic shock was not found to decrease total time to IV vasopressor discontinuation. Although, there were less patients started on a second IV vasopressor in the midodrine group.