In patients with persistent borderline hypotension recovering from sepsis or critical illness, do you use midodrine to avoid escalating to higher levels of care?  

Although midodrine is a medication that can be used to avoid vasopressors, I think it is much more important to give isotonic fluids when the patient would benefit from fluids. It is also very important to determine the etiology of hypotension. Is hypotension related to sepsis? Hypovolemia? Bleeding...

I routinely consider it, but rarely use it. Midodrine must be renally dosed and not used with significant renal impairment, and also causes significant bradycardia. Therefore, most of the patients I would want to consider using it with don’t qualify. Most of my patients have underlying hyperte...