Abstract
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.
Highlights
Intravenous vasopressors (IVVs) are an essential component in the management of shock following adequate fluid resuscitation [1, 2]
Administration (FDA) for the treatment of orthostatic hypotension. It has been used as an off-label agent in the management of several other conditions such as dialysisinduced hypotension [7], hepatorenal syndrome [8], neurogenic hypotension [9], and hypotension associated with carotid artery stenting [10]. ere has been an increasing trend towards using midodrine as an adjunctive agent in an attempt to weaning IVV in patients with resolving shock and in turn reducing their intensive care unit (ICU) and hospital length of stay (LOS) [11]
We found 9 studies that investigated midodrine and IVV use versus using only IVV in ICU settings
Summary
Intravenous vasopressors (IVVs) are an essential component in the management of shock following adequate fluid resuscitation [1, 2]. In some cases, discontinuation of IVV can be challenging due to continued vasoplegia [5] In these cases, continuous need for IVV therapy may prevent patients from being discharged from the intensive care unit (ICU) due to the need for close hemodynamic monitoring and in turn may prolong their hospital length of stay [6]. Administration (FDA) for the treatment of orthostatic hypotension It has been used as an off-label agent in the management of several other conditions such as dialysisinduced hypotension [7], hepatorenal syndrome [8], neurogenic hypotension [9], and hypotension associated with carotid artery stenting [10]. Ere has been an increasing trend towards using midodrine as an adjunctive agent in an attempt to weaning IVV in patients with resolving shock and in turn reducing their ICU and hospital length of stay (LOS) [11]. Midodrine has several side effects including bradycardia, hypertension, ischemia, gastrointestinal upset, piloerection, pruritus, and dysuria that may limit its safety [12, 13]
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