924: Adjunctive Oral Midodrine Use in Critically Ill Patients: Effect on Weaning Intravenous Vasopressors

Fiorenza, Mallory; Barkes, Jordan; Naik, Sagar

doi:10.1097/01.ccm.0000633232.77165.17

Cited by 4 publications

(6 citation statements)

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“…is could have been contributed by the fact that they had sicker patients in the midodrine group as the APACHE III score was significantly higher among the midodrine group (84 vs. 77; p < 0.01). Fiorenza et al [19] (abstract) was the only study to include just extubated patients who still require IVV (less than 15 mcg/hr of norepinephrine equivalent) with different etiologies; this study showed that midodrine decreased hospital LOS, ICU readmission, and IVV reinstitutions. Tremblay et al [16] was the only study to include patients after cardiac surgery with cardiopulmonary bypass, and it showed increased ICU LOS and higher mortality among the midodrine group.…”

Section: Discussionmentioning

confidence: 89%

“…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%

“…(5) ICU readmissions: the heterogeneity was already low in this outcome. However, excluding Tremblay et al [16] or Fiorenza et al [19] dropped I 2 from 11% to 0%. Leave-one-out analyses of the studies evaluating this outcome did not show any significant changes in the results (Supplementary Figures 1E and 2E).…”

Section: Heterogeneity Evaluation and Sensitivity Analysesmentioning

confidence: 97%

“…(4) IVV reinstitution: three studies assessed this outcome; both Fiorenza et al [19] and Whitson et al [13] showed a significant decrease of IVV reinstitution while Poveromo et al [20] did not show a significant difference. Although Baujat plot showed that Whitson et al [13] contributed most to heterogeneity; the lowest possible heterogeneity can be achieved by Critical Care Research and Practice excluding Poveromo et al [20] as it showed different results from the others; this dropped the I 2 from 81% to 0%, and repeating the analysis after excluding it showed the midodrine group now had significantly lower rates of IVV reinstitution (RR 0.47; 95% CI 0.15 to 0.61; I 2 � 0%) (Supplementary Figures 1D and 2D).…”

Section: Heterogeneity Evaluation and Sensitivity Analysesmentioning

confidence: 99%

“…Various observational studies have been done evaluating the effect of midodrine to facilitate IVV weaning [13][14][15][16][17][18][19][20]. Recently, the results from the "Effect of midodrine versus placebo on time to vasopressor discontinuation in patients with persistent hypotension in the intensive care unit (MI-DAS) -an international randomized controlled trial (RCT)" [6] have also been published.…”

Section: Introductionmentioning

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: 89%

Section: Discussionmentioning

confidence: 99%

Section: Heterogeneity Evaluation and Sensitivity Analysesmentioning

confidence: 97%

Section: Heterogeneity Evaluation and Sensitivity Analysesmentioning

confidence: 99%

Section: Introductionmentioning

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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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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Clinical utility of midodrine and methylene blue as catecholamine-sparing agents in intensive care unit patients with shock

Tchen

Sullivan

2020

Journal of Critical Care

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924: Adjunctive Oral Midodrine Use in Critically Ill Patients: Effect on Weaning Intravenous Vasopressors

Cited by 4 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

Clinical utility of midodrine and methylene blue as catecholamine-sparing agents in intensive care unit patients with shock

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