ROLE OF ORAL MIDODRINE IN PATIENTS RECEIVING INTRAVENOUS VASOPRESSORS IN ICU SETTING: A SYSTEMATIC REVIEW

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Hypotension in patients admitted to ICU who otherwise qualify ICU discharge criteria is challenging as hospitals require IV vasopressors be given in ICU. Oral midodrine has been reported as an option to wean off vasopressors. We performed a systematic review to understand the current evidence regarding the efficacy and safety of midodrine. METHODS: A systematic search of PubMed, Ovid Embase, Web of Science, Cochrane library and clinicaltrials.gov was performed. After removing duplicates from initial 124 articles, 94 articles were screened for relevance by two independent reviewers. 33 articles were screened for eligibility. RESULTS: Seven studies were included with N= 2290, including 953 males and 704 females. Among these, 1582 patients received midodrine while 708 patients served as control group. The reporting of APACHE score was heterogeneous. The midodrine dose ranged from 15 mg to 120 mg per day divided into 2-3 doses. There was significant variability in the reporting of outcomes. The total ICU stay was significantly shorter in midodrine group in one study; Whitson et all: 7.5 vs 9.4 days, p= 0.017. While four studies showed a non-significant difference in ICU LOS between patients receiving midodrine and control group. ICU readmissions data was reported by two studies (Poveromo et al & Roach et al) and showed no significant differences. Similarly, no study showed that midodrine reduces the total hospital stay. Although reported only by three studies with variability in results reporting, midodrine was noticed to significantly reduce the total time vasopressor was administered in two of them while Roach et al showed a longer use of vasopressor in the midodrine arm: Whitson et al(Mean:2.9 days vs 3.8 days, p< 0.001), Poveromo et al (median:1.2 days, 0.5- 2.8 days) and Roach et al(Average:17.9 vs.14.7 days, p< 0.01). The ICU and in-hospital mortality data were reported by three studies. Poveromo et al showed statistically significant reduction of in-hospital mortality (8.5% vs. 22.3%, p= 0.01). However, there was a non-significant trend of reduction in ICU/in-hospital mortality reported by Whitson et al (11% vs. 18.6%, p= 0.8) and Rizvi et al (8% vs. 11%). The drug was well tolerated with a manageable toxicity profile. Bradycardia was the most common side effect, ranging between 12.8-16.5%. Midodrine associated hypertension was reported by only one study (Poveromo et al) as incidence of 6.4%. CONCLUSIONS: Midodrine has potential to decrease ICU length of stay and facilitate early weaning off vasopressors. Current literature is still under powered to illustrate the full benefit of midodrine. CLINICAL IMPLICATIONS: Larger randomized controlled trials are needed to further investigate the full potential for use of midodrine in ICU. DISCLOSURES: No relevant relationships by Muhammad Ahsan, source=Web Response No relevant relationships by Siddique Chaudhary, source=Web Response No relevant relationships by Sana Chaudhary, source=Web Response No relevant relationships by HAFIZ MUHAMMAD FAZEEL, source=Web Response No relevant relationships by Gabriel Patarroyo Aponte, source=Web Response No relevant relationships by Amman Yousaf, source=Web Response