Midodrine therapy for vasopressor dependent shock in the intensive care unit: a protocol for a systematic review and meta-analysis

Kamaleldin, Mostafa; Kilcommons, Sebastian; Opgenorth, Dawn; Fiest, Kirsten M.; Karvellas, Constantine; Kutsogiannis, Jim; Lau, Vincent; MacIntyre, Erika; Rochwerg, Bram; Senaratne, Janek; Slemko, Jocelyn; Sligl, Wendy; Wang, Xiaoming; Bagshaw, Sean M.; Rewa, Oleksa

doi:10.1136/bmjopen-2022-064060

Cited by 3 publications

(2 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, while identifying midodrine may reduce ICU LOS, duration of IV vasopressor support, and may even decrease hospital mortality, these studies were all underpowered, imprecise, and contained signi cant risks of bias (25). While potentially important, these ndings are based on low certainty of evidence.…”

mentioning

confidence: 99%

“…Subsequently, several small randomized controlled trials (RCTs) have evaluated the role of midodrine in critically ill patients. Our study team recently completed a systematic review and meta-analysis to examine the role of midodrine in critically ill patients (25). This review identi ed 6 recent RCTs evaluating the role of midodrine in various critically ill populations (16,(18)(19)(20)(21).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Midodrine for the early liberation from vasopressor support in the ICU (LIBERATE): A feasibility study

Kilcommons,

Hammal,

Opgenorth

et al. 2024

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Malnutrition is the most common nutritional disorder in developing countries and it remains one of the most common causes of morbidity and mortality among children worldwide. Childhood malnutrition is a multi-dimensional problem. An increase in household income is not sufficient to reduce childhood malnutrition if children are deprived of food security, education, access to water, sanitation and health services. However, due to regional variations in prevalence of acute malnutrition, it is important to explore the risk factors specific to the region, for designing and implementing public health interventions. Objective: To assess the prevalence and risk factors of malnutrition among children under five years Methods: A descriptive study enrolled 100 children under five years in Helat Hassan Health Centre, Wad-Medani, Gezira State during the period from November 2020 - March 2021. Data regarding children and families characteristics, nutritional history, health and medical history and anthropometric measurements were collected. Malnutrition was defined according to WHO guideline as -3SD of age specific BMI Results: Among 100 children, 59(59%) males and 41(41%) females, their mean age was 33±18 months. The frequency of malnutrition was 10% (n=10) and underweighting was 18% (n=18). Child's related risk factors associated with malnutrition were; children order above 4th (P. value= 0.000) and number of under 5 children in family above 3 children (P. value= 0.00). Family's related risk factors associated with malnutrition were; younger mother blow 30 years (P. value= 0.001), non-mother (relative) caregivers (P. value= 0.000), illiterate mothers (P. value= 0.046), employed mothers (P. value= 0.000), relative as income responsible (P. value= 0.009), lack of medical insurance (P. value= 0.047), lack of in-home source of water (P. value= 0.003), and low income blow 6,000 SDG (P. value= 0.000). Nutritional related risk factors associated with malnutrition were; lack of exclusive breastfeeding (P. value= 0.000), less than three meals per day (P. value= 0.021), lack of vegetables and fruits in daily nutrition (P. value= 0.006) and lack of milk and dietary products in daily nutrition (P. value= 0.000). Health related risk factors associated with malnutrition were; illness as cause of health care center visit (P. value= 0.018), anemia (P. value= 0.002), admission to hospital in last 2 months (P. value= 0.005), fever, cough, runny rose or chest infection in last 2 weeks (P. value= 0.032), chronic diarrhea (20.7%; P. value= 0.018) and history of malnutrition (P. value= 0.001). Conclusion: The frequency of malnutrition is not neglectable in Helat Hassan Health Centre at Wad-Medani. Malnutrition was found to be multi-factorial and associated with child, family, nutritional and health related factors. Effective, efficient and equitable program and intervention should be designed to reduce child malnutrition

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Midodrine for the early liberation from vasopressor support in the ICU (LIBERATE): A feasibility study

Kilcommons,

Hammal,

Opgenorth

et al. 2024

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

Adjunctive Midodrine Therapy for Vasopressor-Dependent Shock in the ICU: A Systematic Review and Meta-Analysis

Kilcommons,

Hammal,

Kamaleldin

et al. 2024

Critical Care Medicine

View full text Add to dashboard Cite

Objectives: To summarize the efficacy of midodrine as an adjunctive therapy in critically ill patients. Safety of midodrine was assessed as a secondary outcome. Data Sources: We performed a systematic review and meta-analysis using a peer-reviewed search strategy combining the themes of vasopressor-dependent shock, critical care, and midodrine and including MEDLINE, Ovid Embase, CINAHL, and Cochrane library databases until September 14, 2023. Study Selection: We included studies if they: 1) included patients with vasopressor-dependent shock, 2) were performed in the ICU, 3) evaluated oral midodrine therapy compared with placebo or usual care, and 4) evaluated one of the outcomes of interest. Data Extraction: We extracted data independently in duplicate using standardized data abstraction forms, which included the following specific variables: patient characteristics, age, sex, type of ICU, etiology of shock, number of patients, study inclusion and exclusion criteria, and geographical location. We also captured the type, dose, and duration of IV vasopressors, any cointervention used, and outcome data. Data Synthesis: We identified seven randomized controlled trials (six included in the pooled analysis) and ten observational studies (four included in the pooled analysis) that met eligibility criteria. Adjunctive midodrine may decrease ICU length of stay (LOS) and there is low certainty of effect on hospital LOS. Midodrine may decrease IV vasopressor support duration, ICU mortality, and hospital mortality. Pooled observational data was based on very low certainty data for all outcomes of interest. The trial sequential analysis-informed required sample size was not met for ICU LOS or IV vasopressor duration and this contributed to Grading of Recommendations, Assessment, Development, and Evaluations assessments of imprecision for both outcomes. Conclusions: Adjunctive midodrine may decrease ICU LOS, duration of IV vasopressor therapy, and mortality in critically ill patients. However, required sample sizes was not met to determine our outcomes of interest. Midodrine may increase risk of bradycardia. While midodrine may provide benefit for patient-centered outcomes, due to increased risk of adverse events, further large-scale studies are needed to inform and guide its routine use in the ICU.

show abstract

Midodrine for the early liberation from vasopressor support in the ICU (LIBERATE): a feasibility study

Kilcommons,

Hammal,

Opgenorth

et al. 2024

Pilot Feasibility Stud

View full text Add to dashboard Cite

Background Intravenous (IV) vasopressors are the mainstay of physiological support for hemodynamically unstable patients. However, the role of oral vasopressors remains unclear. The objective of our study was to evaluate the feasibility of evaluating midodrine for critically ill patients with IV vasopressor-dependent shock. Methods We conducted a single-center, concealed-allocation, parallel-group, blinded feasibility randomized controlled trial (RCT) evaluating the effect of oral midodrine versus placebo on IV vasopressor-dependent shock in the intensive care unit (ICU). The study was performed in a medical-surgical ICU at the University of Alberta Hospital from April 2021 to July 2022. We included patients aged 18 years or older admitted to the ICU with ongoing vasopressor support with decreasing vasopressor dose(s). Patients were randomly assigned 1:1 to midodrine or a placebo for the duration of their IV vasopressor therapy. The primary outcome was study feasibility and secondary outcomes included patient-centered outcomes. Feasibility was assessed through rate of recruitment, adherence to study protocol, and patient safety. Results Twenty patients were enrolled in the study and underwent randomization ( n = 11 midodrine, n = 9 control). Recruitment was recorded at 1.2 participants per month, protocol adherence was 90%, and allocation remained concealed. No adverse events were reported in either group. Sepsis was the most common cause of shock in both groups. The midodrine group had a shorter length of ICU stay of 9.6 (SD 8.7) vs 10.4 (SD 14.5) days. Hospital mortality was lower for the midodrine group ( n = 2, 18.2% vs n = 4, 37.5%). Vasopressor re-initiation after 24 h was more frequent in the midodrine group ( n = 4, 36.4% vs n = 2, 25%). There were no readmissions to the ICU following discharge in either group. Conclusions The evaluation of midodrine for patients in the ICU is feasible and safe. This trial will inform future large-scale RCTs regarding the utility of midodrine in critically ill patients with IV vasopressor-dependent shock. Trial registration This pilot RCT was registered at clinicaltrials.gov (NCT04489589). Registered July 27, 2020. https://clinicaltrials.gov/study/NCT04489589 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-024-01577-2.

show abstract

Midodrine therapy for vasopressor dependent shock in the intensive care unit: a protocol for a systematic review and meta-analysis

Cited by 3 publications

References 30 publications

Midodrine for the early liberation from vasopressor support in the ICU (LIBERATE): A feasibility study

Midodrine for the early liberation from vasopressor support in the ICU (LIBERATE): A feasibility study

Adjunctive Midodrine Therapy for Vasopressor-Dependent Shock in the ICU: A Systematic Review and Meta-Analysis

Midodrine for the early liberation from vasopressor support in the ICU (LIBERATE): a feasibility study

Contact Info

Product

Resources

About