Feasibility, Utility, and Safety of Midodrine During Recovery Phase From Septic Shock

Whitson, Matthew J.; Mo, Edwin; Nabi, Tasnima; Healy, Lauren; Koenig, Seth; Narasimhan, Mangala; Mayo, Paul H.

doi:10.1016/j.chest.2016.02.657

Cited by 60 publications

(93 citation statements)

References 6 publications

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“…Unfortunately, the investigators did not compare the duration of vasopressor treatment between the groups. The largest study published to date comparing midodrine with vasopressors and vasopressors alone evaluated the duration of IV vasopressor administration and ICU length of stay in medical ICU patients with septic shock . Adjunctive midodrine significantly reduced the duration of vasopressor therapy and ICU length of stay, outcomes not seen in the previously cited studies.…”

Section: Midodrinementioning

confidence: 96%

“…The first published evaluation of midodrine's catecholamine‐sparing effects was a prospective observational study that observed a precipitous decline in the vasopressor infusion rate during the first 4 doses of midodrine in surgical ICU patients . Two subsequent retrospective studies evaluated patients treated with adjunctive midodrine to facilitate vasopressor liberation compared with patients treated with vasopressors alone . One study included patients receiving one or more vasopressors for a cardiovascular, trauma, or sepsis‐related hypotension diagnosis .…”

Section: Midodrinementioning

confidence: 99%

“…Vasopressor + midodrine compared with vasopressors alone in medical ICU patients with septic shock (n = 275)…”

Section: Midodrinementioning

confidence: 99%

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Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

et al. 2019

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Shock syndromes are associated with unacceptably high rates of mortality in critically ill patients despite advances in therapeutic options. Vasodilatory shock is the most common type encountered in the intensive care unit. It is manifested by cardiovascular failure, peripheral vasodilatation, and arterial hypotension leading to tissue hypoperfusion and organ failure. Hemodynamic support is typically initiated with fluid resuscitation strategies and administration of adrenergic vasopressor agents in nonresponsive patients to restore arterial pressure with subsequent adequate organ reperfusion. Unfortunately, high catecholamine dosing requirements may be necessary to achieve targeted hemodynamic goals that may increase the risk of vasopressor‐induced adverse events. The purpose of this article is to review the clinical efficacy and safety data and potential role in therapy for catecholamine‐sparing agents in vasodilatory shock. Adjunctive therapeutic options to reduce vasoactive support requirements without compromising arterial pressure include arginine vasopressin and analogs, corticosteroids, midodrine, methylene blue, and angiotensin II. Although concomitant vasopressin and corticosteroids have a more defined role in evidence‐based guidelines for managing shock, clinicians may consider other potential catecholamine‐sparing agents.

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Section: Midodrinementioning

confidence: 96%

Section: Midodrinementioning

confidence: 99%

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Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

et al. 2019

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“…Another recent retrospective study from a medical ICU included 275 patients over one year, with a diagnosis of septic shock and required at least 24 h of IV vasopressors, who were stable or on reducing doses of IV vasopressors. The authors compared patients on IV vasopressors only to those who received IV vasopressors plus adjunctive midodrine (with a starting dose of 10 mg TDS) and showed a reduction in the mean IV vasopressor duration (2.9 days versus 3.8 days, p < 0.001) and reduced ICU length of stay (7.5 versus 9.4 days, p = 0.017) in the IV vasopressor plus midodrine group [9]. …”

Section: Introductionmentioning

confidence: 99%

Midodrine as adjunctive support for treatment of refractory hypotension in the intensive care unit: a multicenter, randomized, placebo controlled trial (the MIDAS trial)

et al. 2017

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BackgroundPatients admitted to intensive care units (ICU) are often treated with intravenous (IV) vasopressors. Persistent hypotension and dependence on IV vasopressors in otherwise resuscitated patients lead to delay in discharge from ICU. Midodrine is an oral alpha-1 adrenergic agonist approved for treatment of symptomatic orthostatic hypotension. This trial aims to evaluate whether oral administration of midodrine is an effective adjunct to standard therapy to reduce the duration of IV vasopressor treatment, and allow earlier discharge from ICU and hospital.MethodsThe MIDAS trial is an international, multicenter, randomized, double-blind, placebo-controlled clinical trial being conducted in the USA and Australia. We are targeting 120 patients. Adult patients admitted to the ICU who are resuscitated and otherwise stable on low dose IV vasopressors for at least 24 h will be considered for recruitment. Participants will be randomized to receive midodrine (20 mg) or placebo three times a day, in addition to standard care. The primary outcome is time (hours) from initiation of midodrine or placebo to discontinuation of IV vasopressors. Secondary outcomes include time (hours) from ICU admission to discharge readiness, ICU length of stay (LOS) (days), hospital LOS (days), rates of ICU readmission, and rates of adverse events related to midodrine administration.DiscussionMidodrine is approved by the Food and Drug Administration (FDA) for the treatment of symptomatic orthostatic hypotension. In August 2010, FDA proposed to withdraw approval of midodrine because of lack of studies that verify the clinical benefit of the drug. We obtained Investigational New Drug (IND 113,330) approval to study its effects in critically ill patients who require IV vasopressors but are otherwise ready for discharge from the ICU. A pilot observational study in a cohort of surgical ICU patients showed that the rate of decline in vasopressor requirements increased after initiation of midodrine treatment. We hypothesize that midodrine administration is effective to wean IV vasopressors and shorten ICU and hospital LOS. This trial may have significant implications on lowering costs of hospital care and obtaining FDA approval for new indications for midodrine.Trial RegistrationThis study has been registered at clinicaltrials.gov on 02/09/2012 (NCT01531959).

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“…The trial was registered at ClinicalTrials.gov. 1 Of the 150 subjects randomized to treatment (mean age, 44.2 years; 50.7% men; 878 TBLB specimens), sarcoidosis was diagnosed in 141 (Fig 1). The baseline characteristics were similar in the two groups (e- Table 2).…”

mentioning

confidence: 99%