The Impact of Midodrine on Duration of Vasopressor Infusion in Patents With Septic Shock in a Community Hospital Setting

Nadhim, Ali; Tun, Zar; Chua, L. Chadrick; majeed, ruwaidah; Ramos, Jane; Najib, Sana

doi:10.1016/j.chest.2019.08.1396

Cited by 2 publications

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

“…Among the prior studies reviewed, Whitson et al [ 13 ], Hailu et al [ 17 ], Liu et al [ 14 ], and Nadhim et al [ 15 ] were the only ones that included patients with septic shock. Whitson et al [ 13 ], Liu et al [ 14 ] (abstract), and Hailu et al [ 17 ] (abstract) showed a significant reduction in IVV duration, ICU LOS, and Hospital LOS while Nadhim et al [ 15 ] (abstract) did not show a significant decrease in IVV duration. Analysis limited to studies that included patients with septic shock was not done as 3 of these studies are just published as abstracts and did not report standard deviations for means or interquartile ranges for medians to pool them in our quantitative analysis.…”

Section: Discussionmentioning

confidence: 99%

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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%

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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“…Norepinephrine is still the first-line agent for vasoplegia, but it requires continuous ICU monitoring that leads to prolonged ICU stays [ 6 ]. A lot of interest has been directed towards using midodrine, an oral alpha-1 agonist, in patients with resolving shock who remain vasopressor-dependent, with the goal of liberating patients from IV pressors [ 18 – 22 ]. Midodrine is approved for the treatment of a variety of conditions, including orthostatic hypotension, neurogenic hypotension [ 11 ], and hypotension caused by carotid artery stenting [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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Background Studies evaluating the role of midodrine as an adjunctive therapy to liberate patients with shock from intravenous (IV) vasopressors have yielded mixed results. The aim of our study was to evaluate the efficacy and safety of midodrine as an adjunctive therapy to liberate patients with shock from IV vasopressors. Methods Electronic searches of the MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) that evaluated the use of midodrine versus control in patients with shock and a low dose of IV vasopressors. The primary outcome was total IV vasopressor time, while the secondary outcomes included time-to-IV vasopressor discontinuation, IV vasopressor restart, intensive care unit (ICU) length of stay (LOS), hospital LOS, and incidence of bradycardia. Results The final analysis included four RCTs with a total of 314 patients: 158 in the midodrine group and 156 in the control group, with a weighted mean age of 64 years (54.2% men). There was no significant difference in the total IV vasopressor time between the midodrine and control groups (standardized mean difference [SMD] − 0.53; 95% confidence interval [CI] − 1.38 to 0.32, p = 0.22; I 2 = 92%). Also, there were no significant differences between the two groups in the time-to-IV vasopressor discontinuation (SMD − 0.05; 95% CI − 0.57 to 0.47, p = 0.09), IV vasopressor restart (19.3 vs. 28.3%; risk ratio [RR] 0.74; 95% 0.25–2.20, p = 0.59), ICU LOS (SMD − 0.49; 95% CI − 1.30 to 0.33, p = 0.24), and hospital LOS (SMD 0.01; 95% CI − 0.27 to 0.29, p = 0.92). However, compared with the control group, the midodrine group had a higher risk of bradycardia (15.3 vs. 2.1% RR 5.56; 95% CI 1.54–20.05, p = 0.01). Conclusions Among patients with vasopressor-dependent shock, midodrine was not associated with early liberation of vasopressor support or shorter ICU or hospital length of stay. Adding midodrine increased the risk of bradycardia. Further large RCTs are needed to better evaluate the efficacy and safety of midodrine in liberating patients from IV vasopressors. Supplementary Information The online version contains supplementary material available at 10.1007/s40119-023-00301-0.

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The Impact of Midodrine on Duration of Vasopressor Infusion in Patents With Septic Shock in a Community Hospital Setting

Cited by 2 publications

References 0 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

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

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