Review Article

Impact of Adjuvant Use of Midodrine to Intravenous Vasopressors: A Systematic Review and Meta-Analysis

Table 1

Characteristics of the included studies.

AuthorType of studyPopulationDuration of enrollmentNumber of patientsCountriesMidodrine doseMain results

Liu, 2010Retrospective (abstract)Patients requiring IVV for septic shockDecember 2007 to December 200940USAMidodrine decreased the duration of IVV

Poveromo, 2016RetrospectivePatients requiring IVVJanuary 2007 to March 2012188USA10 mg every 8 hours (starting dose)Midodrine increased hospital LOS and did not affect ICU LOS or ICU readmissions. Bradycardia occurred in 12.8% in midodrine group compared to 0% in control group

Whitson, 2016RetrospectivePatients with septic shock requiring at least 24 h of IVVNovember 2013 to November 2014275USA10 mg every 8 hours (starting dose)Midodrine decreased duration of IVV, reinstitution of IVV, and ICU LOS. No significant difference in bradycardia rates

Roach, 2017Retrospective (abstract)Patients requiring at least 7 days of IVVSeptember 2013 to September 20162070USA15 mg every 8 hours (starting dose)Midodrine did not significantly decrease duration of IVV, hospital LOS, or ICU LOS. No significant difference in bradycardia rates

Fiorenza, 2019Retrospective (abstract)Patients who received less than 15 mcg/hr of norepinephrine equivalent after extubationDecember 2016 to June 201844USAMidodrine decreased hospital LOS, ICU readmission, and vasopressors reinstitution

Nadhim, 2019Retrospective (abstract)Patients with septic shock requiring at least 24 h of IVVJanuary 2017 to March 201883USAMidodrine did not significantly decrease the duration of IVV

Hailu, 2020Retrospective (abstract)Patients with septic shock requiring at least 24 h of IVVJune 2013 to August 2018166USAMidodrine decreased ICU LOS, hospital LOS, and IVV duration

Tremblay, 2020RetrospectivePatients requiring IVV within the first week after cardiac surgery with cardiopulmonary bypassJanuary 2014 to January 2018148Canada10 mg every 8 hours (starting dose)Midodrine increased ICU LOS and was associated with higher mortality

Santer, 2020 (MIDAS)Randomized controlled trialPatients (adults) requiring single-agent IVV for more than 24 hOctober 2012 to June 2019132USA and Australia20 mg every 8 hoursMidodrine did not decrease time to IV vasopressors discontinuation and was associated with more bradycardia

ICU: intensive care unit; IVV: intravenous vasopressors; LOS: length of stay; MIDAS: effect of midodrine versus placebo on time to vasopressors discontinuation in patients with persistent hypotension in the intensive care unit.