Vasopressor Weaning

A systematic review and meta-analysis found midodrine was associated with shorter IV vasopressor duration and lower hospital mortality. A 32-patient pilot randomized trial found nominal reductions in vasopressor dose and duration, central venous catheter duration, and ICU length of stay in the midodrine arm. Prior studies of midodrine for vasopressor weaning in critically ill patients have produced inconsistent results. The existing evidence justifies a definitive pragmatic trial but does not establish benefit. Studies in postoperative and surgical ICU populations suggested midodrine may accelerate vasopressor liberation, but findings were heterogeneous.