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

Abstract

Consent to participate: Written informed consent was obtained from all subjects or their legally authorised representatives. Consent for publication: Not applicableAvailability of data and material: De-identified data collected during the trial will be made available upon reasonable request to researchers who provide a methodologically sound proposal, after approval by the study authors, and with a signed data access agreement. Questions about data are handled by the corresponding author.

Impact of Adjuvant Use of Midodrine to Intravenous Vasopressors: A Systematic Review and Meta-Analysis

“…Based on our meta-analysis, the addition of midodrine had no effect on the ICU LOS, hospital LOS, mortality, ICU readmission, or IVV reinstitution. To the best of our knowledge, this is the first meta-analysis that includes the data from the MIDAS trial [ 6 ] and Tremblay et al [ 16 ] study.…”

“…Previous retrospective studies and one RCT have been conducted with conflicting results; some showed that midodrine is helpful in this process [ 13 , 14 , 17 , 19 ], and others including the RCT showed no benefit of adding midodrine to facilitate weaning off IVV [ 6 , 15 , 18 ]. Surprisingly, two studies showed that midodrine increases hospital and ICU LOS [ 16 , 20 ].…”

“…Santer et al [ 6 ] (MIDAS trial) showed no significant difference between the two groups in terms of time to discontinuation of IVV (difference +1 day; 95% CI −10.4 to 12.3; p =0.62); ICU LOS (difference 0; 95% CI −0.5 to 0.5 days; p =0.46), and hospital length of stay (difference −3 days; 95% CI −6.3 to 0.3; p =0.46). Though this was a well-designed trial, it had several limitations including a small sample size and a heterogeneous population.…”

“…It is worth mentioning that IVV duration was not studied in our analysis as enough data were only reported in Santer et al [ 6 ] trial which included the majority of surgical patients and Tremblay et al study which included patients after cardiac surgery, and so this makes the results of this outcome inapplicable to others like septic patients.…”

“…However, in some cases, discontinuation of IVV can be challenging due to continued vasoplegia [ 5 ]. In these cases, continuous need for IVV therapy may prevent patients from being discharged from the intensive care unit (ICU) due to the need for close hemodynamic monitoring and in turn may prolong their hospital length of stay [ 6 ]. Midodrine, an oral alpha-1 agonist, was originally approved by U.S. Food and Drug Administration (FDA) for the treatment of orthostatic hypotension.…”