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

Abstract

Purpose. To evaluate the efficacy and safety of midodrine use in intensive care units (ICU) to facilitate weaning off intravenous vasopressors (IVV). Methods. We searched PubMed/MEDLINE, Cochrane library, and Google Scholar (inception through October 18th, 2020) for studies evaluating adjuvant use of midodrine to IVV in the ICU. The outcomes of interest were ICU length of stay (LOS), hospital LOS, mortality, IVV reinstitution, ICU readmission, and bradycardia. Estimates were pooled using the random-effects model. We reported effect sizes as standardized mean difference (SMD) for continuous outcomes and risk ratios (RRs) for other outcomes with a 95% confidence interval (CI). Results. A total of 6 studies were found that met inclusion criteria and had sufficient data for our quantitative analysis (1 randomized controlled trial and 5 retrospective studies). A total of 2,857 patients were included: 600 in the midodrine group and 2,257 patients in the control group. Midodrine use was not associated with a significant difference in ICU LOS (SMD 0.16 days; 95% CI −0.23 to 0.55), hospital LOS (SMD 0.03 days; 95% CI −0.33 to 0.0.39), mortality (RR 0.87; 95% CI 0.52 to 1.46), IVV reinstitution (RR 0.47; 95% CI 0.17 to 1.3), or ICU readmission (RR 1.03; 95% CI 0.71 to 1.49) when compared to using only IVV. However, there were higher trends of bradycardia with midodrine use that did not reach significance (RR 7.64; 95% CI 0.23 to 256.42). Conclusion. This meta-analysis suggests that midodrine was not associated with a significant decrease in ICU LOS, hospital LOS, mortality, or ICU readmissions.

The Use of Midodrine as an Adjunctive Therapy to Liberate Patients from Intravenous Vasopressors: A Systematic Review and Meta-analysis of Randomized Controlled Studies

“…Exploratory analysis showed no difference in results according to the dose of midodrine in included studies. Our study results are in accordance with a prior meta-analysis of observational studies by Al-Abdouh et al, who also demonstrated that the use of midodrine was not associated with significant difference in ICU LOS, hospital LOS, mortality, or ICU readmissions [ 26 ].…”

Utility of Midodrine During the Recovery Phase of Shock: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…The study by Hammond et al 12 involved 3 observational studies, one of which was a non-peer-reviewed abstract. Our study results were comparable with the meta-analysis conducted by Al-Abdouh et al 13 in 2021, which also showed nonsignificant differences for ICU and hospital LOS when using midodrine in addition to IVVs. The meta-analysis by Al-Abdouh et al 13 was conducted using 6 studies, 5 of which were observational and only 1 of them was a randomized controlled trial (MIDAS trial) by Santer et al 5 There are several limitations to our study that should be acknowledged.…”

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

“…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.…”