6/28/23, 11:16 PM MIDAS Pathway Feedback Search Clinical Topics Home Studies MIDAS MIDAS Disease Sepsis and septic shock Trial question What is the role of midodrine on time to vasopressor discontinuation in patients with persistent hypotension in the ICU? Study design Multi-center Double blinded RCT Population Characteristics of study participants 48.5% female N = 136 51.5% male 136 patients (64 female, 68 male) Inclusion criteria: adult patients with hypotension requiring a single-agent intravenous vasopressor for 24 hours Key exclusion criteria: clinical evidence of inadequate tissue oxygenation, hypovolemic shock or hypotension due to adrenal insufficiency, liver failure, chronic renal failure, severe organic heart disease, acute urinary retention, pheochromocytoma, thyrotoxicosis, bradycardia Interventions N=66 midodrine (20 mg PO every 8 hours plus standard care) N=66 placebo (matching placebo every 8 hours plus standard care) https://web.pathway.md/studies/recfCad2ppszzdeH2 1/2 6/28/23, 11:16 PM MIDAS Pathway Primary outcome Median time to vasopressor discontinuation 23.5 hours 23.5 22.5 17.6 hours 11.8 hours 5.9 hours No significant difference 0.0 hours Midodrine Placebo No significant difference in median time to vasopressor discontinuation (23.5 hours vs. 22.5 hours; AD 1 hours, 95% CI -10.4 to 12.3) Secondary outcomes No significant difference in median hospital length of stay (11 days vs. 14 days; AD -3 days, 95% CI -6.3 to 0.3) Safety outcomes No significant difference in adverse event rates. Significant difference in bradycardia (7.6% vs. 0%). Conclusion In adult patients with hypotension requiring a single-agent intravenous vasopressor for 24 hours, midodrine was not superior to placebo with respect to median time to vasopressor discontinuation. Reference Peter Santer, Matthew H Anstey, Maria D Patroc nio et al. Effect of midodrine versus placebo on time to vasopressor discontinuation in patients with persistent hypotension in the intensive care unit (MIDAS): an international randomised clinical trial. Intensive Care Med. 2020 Oct;46(10):1884-1893. Open reference URL https://web.pathway.md/studies/recfCad2ppszzdeH2 2/2