Effect of midodrine versus placebo on time to vasopressor discontinuation in patients with persistent hypotension in the
- PDF / 1,477,907 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 88 Downloads / 157 Views
ORIGINAL
Effect of midodrine versus placebo on time to vasopressor discontinuation in patients with persistent hypotension in the intensive care unit (MIDAS): an international randomised clinical trial Peter Santer1 , Matthew H. Anstey2,3 , Maria D. Patrocínio1, Bradley Wibrow2,3, Bijan Teja4, Denys Shay1 , Shahzad Shaefi1, Charles S. Parsons5, Timothy T. Houle6 and Matthias Eikermann1,7* on behalf of the MIDAS Study Group © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Abstract Purpose: ICU discharge is often delayed by a requirement for intravenous vasopressor medications to maintain normotension. We hypothesised that the administration of midodrine, an oral α1-adrenergic agonist, as adjunct to standard treatment shortens the duration of intravenous vasopressor requirement. Methods: In this multicentre, randomised, controlled trial including three tertiary referral hospitals in the US and Australia, we enrolled adult patients with hypotension requiring a single-agent intravenous vasopressor for ≥ 24 h. Subjects received oral midodrine (20 mg) or placebo every 8 h in addition to standard care until cessation of intravenous vasopressors, ICU discharge, or occurrence of adverse events. The primary outcome was time to vasopressor discontinuation. Secondary outcomes included time to ICU discharge readiness, ICU and hospital lengths of stay, and ICU readmission rates. Results: Between October 2012 and June 2019, 136 participants were randomised, of whom 132 received the allocated intervention and were included in the analysis (modified intention-to-treat approach). Time to vasopressor discontinuation was not different between midodrine and placebo groups (median [IQR], 23.5 [10–54] vs 22.5 [10.4–40] h; difference, 1 h; 95% CI − 10.4 to 12.3 h; p = 0.62). No differences in secondary endpoints were observed. Bradycardia occurred more often after midodrine administration (5 [7.6%] vs 0 [0%], p = 0.02).
*Correspondence: [email protected] 1 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA Full author information is available at the end of the article Peter Santer and Matthew H. Anstey contributed equally and share first authorship. The members of the MIDAS study group are listed in “Acknowledgements”. A conference abstract reporting findings of this trial was submitted and accepted for presentation at the annual meeting of the American Society of Anesthesiologists (October 2–5, 2020).
Conclusion: Midodrine did not accelerate liberation from intravenous vasopressors and was not effective for the treatment of hypotension in critically ill patients. Keywords: Midodrine, Oral vasopressor, Persistent hypotension, ICU discharge
Introduction
Take‑home message
Patients admitted to intensive care units (ICU) often require intravenous vasoactive medications to maintain normotension or other clinically indicated blood pressure goals [1]. A subset of patients with resolution of acu
Data Loading...
