Safety of Oral Midodrine as a Method of Weaning From Intravenous Vasoactive Medication in the Medical Intensive Care Unit

Cárdenas-García, José; Withson, Micah; Healy, Lauren; Koenig, Seth; Narasimhan, Managala; Mayo, Paul H.

doi:10.1378/chest.1990326

Cited by 9 publications

(10 citation statements)

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“…e current study showed that the ICU LOS in the midodrine (3-7 days) and minirin groups (4-8 days) was shorter than in the control group (4-13 days). is comes in line with the study performed by Cardenas-Garcia et al [12], who reported that there was a reduction in the mean IV vasopressor duration (2.9 days versus 3.8 days, P < 0.001) and the ICU length of stay (7.5 versus 9.4 days, P � 0.017) in the IV vasopressor plus the midodrine group. However, comes in inferior with the study performed by Whitson et al [13], which revealed that the ICU LOS in patients who received IV vasopressors with midodrine was 7.5 ± 5.9 days versus 9.4 ± 6.7 days in patients who received IV vasopressors only.…”

Section: Discussionsupporting

confidence: 91%

Effect of Oral Vasopressors Used for Liberation from Intravenous Vasopressors in Intensive Care Unit Patients Recovering from Spinal Shock: A Randomized Controlled Trial

Ali

EL-Aziz

Abdelhafez

et al. 2022

Critical Care Research and Practice

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Background. Early vasopressor utilization has been associated with improved outcomes of patients with spinal shock; however, there are difficulties in weaning off vasopressors, in which patients after recovery from spinal shock develop a state of persistent vasodilation, which may take a few days to resolve and delays the discharge in the intensive care unit (ICU). Therefore, we tested the hypothesis using two oral vasopressors (midodrine and minirin) to facilitate weaning off intravenous vasopressors, reducing the ICU length of stay, and compare them for more efficacy. Methods. A randomized controlled trial was conducted in the trauma ICU at the Assiut University Hospital in Egypt in patients with spinal shock who required intravenous vasopressor for ≥24 h. A convenience sample was classified into three groups, in which 30 patients were included for each group. The midodrine group received midodrine 10 mg per oral every 8 h with gradual weaning off intravenous (IV) vasopressor (noradrenaline) after receiving 4 doses, the minirin group received minirin 60 μg per oral every 8 h with gradual weaning off IV vasopressor after receiving 4 doses, whereas the control group received IV vasopressor (noradrenaline) with gradual weaning according to the routine hospital care without adding oral vasopressors. The primary outcome was shortening the duration of IV vasopressor requirements. The secondary outcome was reducing the ICU length of stay. Results. Our results showed that the duration of IV vasopressor requirements in the midodrine (3.3 ± 1.32) and minirin groups (4.8 ± 1.83) was significantly lower than in the control group (6.93 ± 2.32). Additionally, the ICU length of stay (days) in the midodrine (5.13 ± 1.83) and minirin groups (5.5 ± 1.91) was significantly lower than in the control group (9.03 ± 3.74). Conclusion. Midodrine and minirin accelerated liberation from intravenous noradrenaline and effective in reducing the ICU length of stay in patients with spinal shock.

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Section: Discussionsupporting

confidence: 91%

Effect of Oral Vasopressors Used for Liberation from Intravenous Vasopressors in Intensive Care Unit Patients Recovering from Spinal Shock: A Randomized Controlled Trial

Ali

EL-Aziz

Abdelhafez

et al. 2022

Critical Care Research and Practice

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“…Midodrine has been increasingly used as an off-label medication to facilitate liberation from intravenous vasopressors and promote ICU discharge [7]. However, while the use of midodrine for the treatment of hypotension in the ICU has some observational support [7][8][9], it has not been studied in interventional clinical trials.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…1,2 In recent years, the initiation of midodrine as an oral agent to assist with weaning of and decreased exposure to intravenous (IV) vasopressor agents has been studied. [3][4][5][6][7][8][9][10] Midodrine has the potential to positively affect intensive care unit (ICU) length of stay (LOS) and resource utilization by reducing the need to continuously monitor hemodynamics and titrate an IV vasopressor. However, patients in whom IV vasopressor therapy is discontinued and midodrine is initiated may be at risk of clinically significant hypotension development.…”

Section: Introductionmentioning

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%

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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Safety of Oral Midodrine as a Method of Weaning From Intravenous Vasoactive Medication in the Medical Intensive Care Unit

Cited by 9 publications

References 0 publications

Effect of Oral Vasopressors Used for Liberation from Intravenous Vasopressors in Intensive Care Unit Patients Recovering from Spinal Shock: A Randomized Controlled Trial

Effect of Oral Vasopressors Used for Liberation from Intravenous Vasopressors in Intensive Care Unit Patients Recovering from Spinal Shock: A Randomized Controlled Trial

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

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

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