Effect of midodrine vs placebo on time to vasopressor discontinuation in patients with persistent hypotension in the intensive care unit (MIDAS): An international randomised clinical trial

Given that a need for intravenous vasopressor medications to maintain normotension commonly delays ICU discharge, and therefore, this multicentre, randomised, controlled trial was undertaken to investigate whether midodrine, an oral α1-adrenergic agonist, used as adjunct to standard treatment can shorten the duration of intravenous vasopressor need. Enrollment of adult patients with hypotension needing a single-agent intravenous vasopressor for ≥ 24 h was done. Patients were administered oral midodrine (20 mg) or placebo every 8 h in addition to standard care until cessation of intravenous vasopressors, ICU discharge, or development of adverse events. Findings revealed no accelerated liberation from intravenous vasopressors in relation to treatment with midodrine. Also, no effectiveness of midodrine was evident as a treatment option for hypotension in critically ill patients.