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

Hammond, Drayton A.; Smith, Melanie; Peksa, Gary D.; Trivedi, Abhaya; Balk, R.A.; Menich, Bryan

doi:10.1177/0885066619843279

Cited by 17 publications

(19 citation statements)

References 29 publications

(58 reference statements)

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“…Surprisingly, two studies showed that midodrine increases hospital and ICU LOS [ 16 , 20 ]. Based on these conflicting results, our meta-analysis was performed to solve this dilemma as new studies have been published after the last meta-analysis by Hammond et al [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

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

Al‐Abdouh

Haddadin

Matta

et al. 2021

Critical Care Research and Practice

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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.

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Section: Discussionmentioning

confidence: 99%

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

Al‐Abdouh

Haddadin

Matta

et al. 2021

Critical Care Research and Practice

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“…Midodrine is another oral vasoconstrictor frequently administered to reduce the time to norepinephrine weaning. Midodrine has been inconsistently associated with shorter vasopressor administration and ICU length of stay [ 114 , 115 , 116 ]. The recent MIDAS (effect of midodrine versus placebo on time to vasopressor discontinuation in patients with persistent hypotension in the intensive care unit) trial reported that midodrine did not reduce time to vasopressor discontinuation in patients with persistent hypotension [ 79 ].…”

Section: Resultsmentioning

confidence: 99%

Vasopressor-Sparing Strategies in Patients with Shock: A Scoping-Review and an Evidence-Based Strategy Proposition

Guinot

Martin

Berthoud

et al. 2021

JCM

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Despite the abundant literature on vasopressor therapy, few studies have focused on vasopressor-sparing strategies in patients with shock. We performed a scoping-review of the published studies evaluating vasopressor-sparing strategies by analyzing the results from randomized controlled trials conducted in patients with shock, with a focus on vasopressor doses and/or duration reduction. We analyzed 143 studies, mainly performed in septic shock. Our analysis demonstrated that several pharmacological and non-pharmacological strategies are associated with a decrease in the duration of vasopressor therapy. These strategies are as follows: implementing a weaning strategy, vasopressin use, systemic glucocorticoid administration, beta-blockers, and normothermia. On the contrary, early goal directed therapies, including fluid therapy, oral vasopressors, vitamin C, and renal replacement therapy, are not associated with an increase in vasopressor-free days. Based on these results, we proposed an evidence-based vasopressor management strategy.

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

Cited by 17 publications

References 29 publications

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

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

Vasopressor-Sparing Strategies in Patients with Shock: A Scoping-Review and an Evidence-Based Strategy Proposition

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

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