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The following is a summary of “Adjunctive Midodrine Therapy for Vasopressor-Dependent Shock in the ICU: A Systematic Review and Meta-Analysis,” published in the December 2024 issue of Critical Care by Kilcommons et al. 

Researchers conducted a retrospective study to summarize the efficacy and safety of midodrine as adjunctive therapy in patients with critical illness.  

They used a peer-reviewed search strategy combining the themes of vasopressor-dependent shock, critical care, and midodrine, searching MEDLINE, Ovid Embase, CINAHL, and the Cochrane Library databases until September 14, 2023. Studies were included if they: involved patients with vasopressor-dependent shock, performed in the ICU) compared oral midodrine therapy with placebo or usual care, and evaluated 1 of the outcomes of interest. 

The results showed that 7 randomized controlled trials (6 in the pooled analysis) and 10 observational studies (4 in the pooled analysis) met eligibility criteria. Adjunctive midodrine may reduce ICU length of stay (LOS), with low certainty of effect on hospital LOS. Midodrine may also reduce IV vasopressor support duration, ICU mortality, and hospital mortality. Pooled observational data was based on very low certainty for all outcomes. The trial sequential analysis indicated that the required sample size for ICU LOS and IV vasopressor duration was not met, leading to imprecision in the Grading of Recommendations, Assessment, Development, and Evaluations assessments for both outcomes. 

Investigators concluded the adjunctive midodrine might reduce the ICU LOS, duration of IV vasopressor therapy, and mortality in patients with critical illness, but due to unmet sample sizes and increased risk of bradycardia, further large-scale studies are needed to guide its routine use in the ICU. 

Source: journals.lww.com/ccmjournal/fulltext/9900/adjunctive_midodrine_therapy_for.426.aspx