200: Impact of Oral Midodrine on Duration of Intravenous Vasopressor Therapy

Roach, Erin; Adie, Sarah; Gowan, Mollie; Chen, Alyssa; Bass, Stephanie; Bauer, Seth; Lam, Simon; Torbic, Heather; Sasidhar, Madhu

doi:10.1097/01.ccm.0000528219.66628.6d

Cited by 13 publications

(15 citation statements)

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“…Patients in the midodrine group in the largest study had significantly greater Acute Physiology and Chronic Health Evaluation III scores (84 vs 77, P < .01) and a greater percentage of patients with septic shock (70.8% vs 57.8%, P < .01). 5 In the study with the least risk of bias and similar patients in both groups, ICU LOS was 1.9 days shorter. 3 Although duration of IV vasopressor infusion from the time midodrine could have been initiated was similar between the groups, significant variability around the point estimates limits the ability to draw confident conclusions from this finding.…”

Section: Discussionmentioning

confidence: 91%

“…Two of the studies were published, 3,4 while the third was a published abstract. 5 Patients from a variety of ICUs and categories of shock were included. Risk of bias results are summarized in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Despite the pathophysiological rationale for initiating midodrine to facilitate vasopressor weaning, uncertainty related to the extent of vasoconstriction provided by midodrine has led investigators to utilize various initiation and titration strategies that may potentially explain discordant findings in observational studies. [3][4][5][6][7][8][9][10] This systematic review and meta-analysis were performed to evaluate the effects of the addition of midodrine to IV vasopressors on clinically significant outcomes in adult patients recovering from shock.…”

Section: Introductionmentioning

confidence: 99%

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Midodrine as an Adjuvant to Intravenous Vasopressor Agents in Adults With Resolving Shock: Systematic Review and Meta-Analysis

Hammond

Smith

Peksa

et al. 2019

J Intensive Care Med

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Purpose: To evaluate the effects of midodrine in addition to intravenous vasopressor therapy on outcomes in adults recovering from shock. Materials and Methods: PubMed, Scopus, Clinicaltrials.gov, and published abstracts were searched from inception to November 2018 for studies comparing outcomes in shock after midodrine initiation versus no midodrine. Results: Three studies with 2533 patients were included. Patients in whom midodrine was added to intravenous vasopressor therapy compared to intravenous vasopressor therapy alone experienced similar intensive care unit (ICU; mean difference [MD]: 1.38 days, 95% confidence interval [CI]: −3.48 to 6.23, I2 = 93%) and hospital lengths of stay (MD: 4.37 days, 95% CI: −3.45 to 12.19, I2 = 93%) and intravenous vasopressor duration after midodrine initiation (MD: 7.28 days, 95% CI: −0.86 to 15.41, I2 = 97%). Mortality was similar between groups (odds ratio: 0.74, 95% CI: 0.44-1.27, I2 = 65%). Qualitative assessment of reporting biases revealed minimal location bias, moderate selective outcome reporting bias, no selective analysis reporting bias, and no conflict of interest bias. Conclusions: Midodrine had no effect on ICU or hospital length of stay. These results were highly susceptible to the study heterogeneity and availability. Future investigation into standardized initiation of midodrine at an adequate dosage with an expedited titration strategy is needed in order to assess the utility of this strategy in shock management.

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Section: Discussionmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Midodrine as an Adjuvant to Intravenous Vasopressor Agents in Adults With Resolving Shock: Systematic Review and Meta-Analysis

Hammond

Smith

Peksa

et al. 2019

J Intensive Care Med

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“…This finding is in keeping with the primary outcome of MIDAS, the only appropriatelypowered, randomised study of this question, 7 as well as several other studies and meta-analyses which showed no effect of midodrine on similar outcomes. [12][13][14][15] Earlier retrospective or observational studies demonstrated that midodrine accelerated either liberation from vasopressors or discharge from the ICU. 1,6,16 These differences are likely due to heterogeneous study populations, retrospective or observational designs and differing dose regimens.…”

Section: Discussionmentioning

confidence: 99%

Oral midodrine does not expedite liberation from protracted vasopressor infusions: A case-control study

Wood

Rauniyar

Jacques

et al. 2022

Anaesth Intensive Care

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Vasopressor dependence is a common problem affecting patients in the recovery phase of critical illness, often necessitating intensive care unit (ICU) admission and other interventions which carry associated risks. Midodrine is an orally administered vasopressor which is commonly used off-label to expedite weaning from vasopressor infusions and facilitate discharge from ICU. We performed a single-centre, case-control study to assess whether midodrine accelerated liberation from vasopressor infusions in patients who were vasopressor dependent. Cases were identified at the discretion of treating intensivists and received 20 mg oral midodrine every eight h from enrolment. Controls received placebo. Data on duration and dose of vasopressor infusion, haemodynamics and adverse events were collected. Between 2012 and 2019, 42 controls and 19 cases were recruited. Cases had received vasopressor infusions for a median of 94 h versus 29.3 h for controls, indicating prolonged vasopressor dependence amongst cases. Midodrine use in cases was not associated with faster weaning of intravenous (IV) vasopressors (26 h versus 24 h for controls, P = 0.51), ICU or hospital length of stay after adjustment for confounders. Midodrine did not affect mean heart rate but was associated with bradycardia. This case-control study demonstrates that midodrine has limited efficacy in expediting weaning from vasopressor infusions in patients who have already received relatively prolonged courses of these infusions.

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“… 13 14 However, these data are not supported by more recent studies. 15 One of most recent trial investigating the use of midodrine in critically ill patients, the MIDAS study, found no difference between placebo and midodrine groups in intravenous vasopressor duration or ICU LoS. 16 However, this study had several important limitations including small size and prolonged recruitment period, which may reflect a participant selection bias and being underpowered to detect a significant difference between groups.…”

Section: Introductionmentioning

confidence: 85%

Midodrine therapy for vasopressor dependent shock in the intensive care unit: a protocol for a systematic review and meta-analysis

et al. 2022

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IntroductionIntensive care unit (ICU) lengths of stay are modified by ongoing need for haemodynamic support in critically ill patients. This is most commonly provided by intravenous vasopressor therapy. Midodrine has been used as an oral agent for haemodynamic support in patients with orthostatic hypotension or cirrhosis. However, its efficacy in treating shock in the ICU, particularly for patients weaning from intravenous vasopressors, remains uncertain. The objective of this systematic review is to determine the efficacy of midodrine in vasopressor dependent shock.Methods and analysisWe will search Ovid MEDLINE, Ovid Embase, CINAHL and Cochrane Library for observational trials and randomised controlled trials evaluating midodrine in critically ill patients from inception to 21 April 2022. We will also review unpublished data and relevant conference abstracts. Outcomes will include ICU length of stay, duration of intravenous vasopressor support, ICU mortality, hospital mortality, hospital length of stay and rates of ICU readmission. Data will be analysed in aggregate, where appropriate. We will evaluate risk of bias using the modified Cochrane tool and certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluations methodology. We will perform trial sequential analysis for the outcome of ICU length of stay.Ethics and disseminationEthics approval is not required as primary data will not be collected. Findings of this review will be disseminated through peer-related publication and will inform future clinical trials.PROSPERO registration numberCRD42021260375.

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200: Impact of Oral Midodrine on Duration of Intravenous Vasopressor Therapy

Cited by 13 publications

References 0 publications

Midodrine as an Adjuvant to Intravenous Vasopressor Agents in Adults With Resolving Shock: Systematic Review and Meta-Analysis

Midodrine as an Adjuvant to Intravenous Vasopressor Agents in Adults With Resolving Shock: Systematic Review and Meta-Analysis

Oral midodrine does not expedite liberation from protracted vasopressor infusions: A case-control study

Midodrine therapy for vasopressor dependent shock in the intensive care unit: a protocol for a systematic review and meta-analysis

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