The Use of Midodrine as an Adjunctive Therapy to Liberate Patients from Intravenous Vasopressors: A Systematic Review and Meta-analysis of Randomized Controlled Studies.
Mohamed Hamed, Sheref A Elseidy, Ahmed Elkheshen, Jamal Maher, Adel Elmoghrabi, Ahmed Zaghloul, Andrew Panakos, Sidakpal Panaich, Marwan Saad, Ayman Elbadawi
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引用次数: 0
Abstract
Background: Studies evaluating the role of midodrine as an adjunctive therapy to liberate patients with shock from intravenous (IV) vasopressors have yielded mixed results. The aim of our study was to evaluate the efficacy and safety of midodrine as an adjunctive therapy to liberate patients with shock from IV vasopressors.
Methods: Electronic searches of the MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) that evaluated the use of midodrine versus control in patients with shock and a low dose of IV vasopressors. The primary outcome was total IV vasopressor time, while the secondary outcomes included time-to-IV vasopressor discontinuation, IV vasopressor restart, intensive care unit (ICU) length of stay (LOS), hospital LOS, and incidence of bradycardia.
Results: The final analysis included four RCTs with a total of 314 patients: 158 in the midodrine group and 156 in the control group, with a weighted mean age of 64 years (54.2% men). There was no significant difference in the total IV vasopressor time between the midodrine and control groups (standardized mean difference [SMD] - 0.53; 95% confidence interval [CI] - 1.38 to 0.32, p = 0.22; I2 = 92%). Also, there were no significant differences between the two groups in the time-to-IV vasopressor discontinuation (SMD - 0.05; 95% CI - 0.57 to 0.47, p = 0.09), IV vasopressor restart (19.3 vs. 28.3%; risk ratio [RR] 0.74; 95% 0.25-2.20, p = 0.59), ICU LOS (SMD - 0.49; 95% CI - 1.30 to 0.33, p = 0.24), and hospital LOS (SMD 0.01; 95% CI - 0.27 to 0.29, p = 0.92). However, compared with the control group, the midodrine group had a higher risk of bradycardia (15.3 vs. 2.1% RR 5.56; 95% CI 1.54-20.05, p = 0.01).
Conclusions: Among patients with vasopressor-dependent shock, midodrine was not associated with early liberation of vasopressor support or shorter ICU or hospital length of stay. Adding midodrine increased the risk of bradycardia. Further large RCTs are needed to better evaluate the efficacy and safety of midodrine in liberating patients from IV vasopressors.
背景:评价midodrine作为一种辅助治疗来解放静脉(IV)血管加压药物对休克患者的作用的研究得出了不同的结果。本研究的目的是评价midodrine作为一种辅助治疗，使休克患者从静脉血管加压药物中解脱出来的有效性和安全性。方法:通过MEDLINE、EMBASE和Cochrane数据库的电子检索，检索到2022年4月之前的随机对照试验(rct)，这些试验评估了在休克和低剂量静脉加压药物患者中使用midodrine与对照组的比较。主要终点是静脉加压药物总时间，次要终点包括静脉加压药物停药时间、静脉加压药物重新启动时间、重症监护病房(ICU)住院时间(LOS)、住院时间(LOS)和心动过缓发生率。结果:最终分析纳入4项随机对照试验，共314例患者:米多定组158例，对照组156例，加权平均年龄为64岁(男性54.2%)。midodrine组与对照组总静脉加压时间无显著差异(标准化平均差[SMD] - 0.53;95%置信区间[CI] - 1.38 ~ 0.32, p = 0.22;i2 = 92%)。此外，两组在静脉停药时间上也无显著差异(SMD - 0.05;95% CI - 0.57 ~ 0.47, p = 0.09)，静脉加压药物重启(19.3% vs. 28.3%;风险比[RR] 0.74;95% 0.25 ~ 2.20, p = 0.59)， ICU LOS (SMD - 0.49;95% CI - 1.30 ~ 0.33, p = 0.24)和医院LOS (SMD 0.01;95% CI - 0.27 ~ 0.29, p = 0.92)。然而，与对照组相比，midodrine组发生心动过缓的风险更高(15.3 vs. 2.1% RR 5.56;95% CI 1.54 ~ 20.05, p = 0.01)。结论:在血管加压剂依赖性休克患者中，米多卡因与早期解除血管加压剂支持或缩短ICU或住院时间无关。添加midodrine增加了心动过缓的风险。需要进一步的大型随机对照试验来更好地评估midodrine在解除静脉血管加压药物患者中的有效性和安全性。
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Cardiology and Therapy is an international, open access, peer reviewed (single-blind), rapid-publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of cardiovascular therapies and interventions, including devices. Studies relating to diagnosis and diagnostics, pharmacoeconomics, public health, quality of life, as well as patient care, management and education are also encouraged.
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