{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T19:34:16Z","timestamp":1765740856959,"version":"3.48.0"},"reference-count":30,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T00:00:00Z","timestamp":1669161600000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018911","name":"University Hospital Foundation","doi-asserted-by":"publisher","award":["RES0052298"],"award-info":[{"award-number":["RES0052298"]}],"id":[{"id":"10.13039\/501100018911","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,11,1]]},"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Intensive care unit (ICU) lengths of stay are modified by ongoing need for haemodynamic support in critically ill patients. This is most commonly provided by intravenous vasopressor therapy. Midodrine has been used as an oral agent for haemodynamic support in patients with orthostatic hypotension or cirrhosis. However, its efficacy in treating shock in the ICU, particularly for patients weaning from intravenous vasopressors, remains uncertain. The objective of this systematic review is to determine the efficacy of midodrine in vasopressor dependent shock.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will search Ovid MEDLINE, Ovid Embase, CINAHL and Cochrane Library for observational trials and randomised controlled trials evaluating midodrine in critically ill patients from inception to 21 April 2022. We will also review unpublished data and relevant conference abstracts. Outcomes will include ICU length of stay, duration of intravenous vasopressor support, ICU mortality, hospital mortality, hospital length of stay and rates of ICU readmission. Data will be analysed in aggregate, where appropriate. We will evaluate risk of bias using the modified Cochrane tool and certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluations methodology. We will perform trial sequential analysis for the outcome of ICU length of stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval is not required as primary data will not be collected. Findings of this review will be disseminated through peer-related publication and will inform future clinical trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42021260375.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-064060","type":"journal-article","created":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T14:05:15Z","timestamp":1669212315000},"page":"e064060","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Midodrine therapy for vasopressor dependent shock in the intensive care unit: a protocol for a systematic review and meta-analysis"],"prefix":"10.1136","volume":"12","author":[{"given":"Mostafa","family":"Kamaleldin","sequence":"first","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Kilcommons","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3571-3871","authenticated-orcid":false,"given":"Dawn","family":"Opgenorth","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"},{"name":"Department of Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7299-6594","authenticated-orcid":false,"given":"Kirsten","family":"Fiest","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constantine Jason","family":"Karvellas","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"},{"name":"Department of Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jim","family":"Kutsogiannis","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"},{"name":"Department of Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Lau","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"},{"name":"Department of Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika","family":"MacIntyre","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"},{"name":"Department of Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bram","family":"Rochwerg","sequence":"additional","affiliation":[{"name":"Department of Medicine and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2320-8926","authenticated-orcid":false,"given":"Janek","family":"Senaratne","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"},{"name":"Department of Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jocelyn","family":"Slemko","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"},{"name":"Department of Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Sligl","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"},{"name":"Department of Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoming","family":"Wang","sequence":"additional","affiliation":[{"name":"Statistical and Analytical Methods, Alberta Health Services, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean M","family":"Bagshaw","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"},{"name":"Department of Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8718-0547","authenticated-orcid":false,"given":"Oleksa G","family":"Rewa","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"},{"name":"Department of Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,11,23]]},"reference":[{"key":"2025121411300477000_12.11.e064060.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1208943"},{"key":"2025121411300477000_12.11.e064060.2","doi-asserted-by":"crossref","DOI":"10.1186\/s13613-021-00806-8","article-title":"Current use of inotropes in circulatory shock","volume":"11","author":"Scheeren","year":"2021","journal-title":"Ann Intensive Care"},{"key":"2025121411300477000_12.11.e064060.3","doi-asserted-by":"crossref","DOI":"10.1186\/s40360-016-0063-z","article-title":"Temporal trends in the utilization of vasopressors in intensive care units: an epidemiologic study","volume":"17","author":"Thongprayoon","year":"2016","journal-title":"BMC Pharmacol Toxicol"},{"key":"2025121411300477000_12.11.e064060.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-018-5085-0"},{"key":"2025121411300477000_12.11.e064060.5","doi-asserted-by":"publisher","DOI":"10.1177\/1074248414559838"},{"key":"2025121411300477000_12.11.e064060.6","doi-asserted-by":"publisher","DOI":"10.1097\/00075198-200206000-00007"},{"key":"2025121411300477000_12.11.e064060.7","doi-asserted-by":"crossref","unstructured":"Appenrodt B , Wolf A , Gr\u00fcnhage F , et al . Prevention of paracentesis-induced circulatory dysfunction: midodrine vs albumin. A randomized pilot study. ;28:(1478-3231 (Electronic)):1019\u201325.doi:10.1111\/j.1478-3231.2008.01734.x","DOI":"10.1111\/j.1478-3231.2008.01734.x"},{"key":"2025121411300477000_12.11.e064060.8","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21094"},{"key":"2025121411300477000_12.11.e064060.9","first-page":"e45","article-title":"The role of midodrine for hypotension outside of the intensive care unit","volume":"24","author":"Gutman","year":"2017","journal-title":"J Popul Ther Clin Pharmacol"},{"key":"2025121411300477000_12.11.e064060.10","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1212\/WNL.0000000000000815","article-title":"Midodrine for orthostatic hypotension and recurrent reflex syncope: a systematic review","volume":"83","author":"Izcovich","year":"2014","journal-title":"Neurology"},{"key":"2025121411300477000_12.11.e064060.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2008.09.001"},{"key":"2025121411300477000_12.11.e064060.12","doi-asserted-by":"crossref","first-page":"2553","DOI":"10.1093\/ndt\/gfh420","article-title":"Midodrine appears to be safe and effective for dialysis-induced hypotension: a systematic review","volume":"19","author":"Prakash","year":"2004","journal-title":"Nephrol Dial Transplant"},{"key":"2025121411300477000_12.11.e064060.13","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1111\/jcpt.12375","article-title":"Midodrine for the weaning of vasopressor infusions","volume":"41","author":"Poveromo","year":"2016","journal-title":"J Clin Pharm Ther"},{"key":"2025121411300477000_12.11.e064060.14","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1016\/j.chest.2016.02.657","article-title":"Feasibility, utility, and safety of midodrine during recovery phase from septic shock","volume":"149","author":"Whitson","year":"2016","journal-title":"Chest"},{"key":"2025121411300477000_12.11.e064060.15","doi-asserted-by":"crossref","DOI":"10.1097\/01.ccm.0000528219.66628.6d","article-title":"200: impact of oral midodrine on duration of intravenous vasopressor therapy","volume":"46","author":"Roach","year":"2018","journal-title":"Crit Care Med"},{"key":"2025121411300477000_12.11.e064060.16","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1007\/s00134-020-06216-x","article-title":"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","volume":"46","author":"Santer","year":"2020","journal-title":"Intensive Care Med"},{"key":"2025121411300477000_12.11.e064060.17","doi-asserted-by":"crossref","DOI":"10.1007\/s11845-021-02903-w","article-title":"Midodrine improves clinical and economic outcomes in patients with septic shock: a randomized controlled clinical trial","author":"Adly","year":"2022","journal-title":"Ir J Med Sci"},{"key":"2025121411300477000_12.11.e064060.18","article-title":"Effect of oral vasopressors used for liberation from intravenous vasopressors in intensive care unit patients recovering from spinal shock: a randomized controlled trial","volume":"2022","author":"Ahmed Ali","year":"2022","journal-title":"Crit Care Res Pract"},{"key":"2025121411300477000_12.11.e064060.19","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.jcrc.2021.11.004","article-title":"A pilot, feasibility, randomised controlled trial of midodrine as adjunctive vasopressor for low-dose vasopressor-dependent hypotension in intensive care patients: the MAVERIC study","volume":"67","author":"Costa-Pinto","year":"2022","journal-title":"J Crit Care"},{"key":"2025121411300477000_12.11.e064060.20","article-title":"Impact of adjuvant use of midodrine to intravenous vasopressors: a systematic review and meta-analysis","volume":"2021","author":"Al-Abdouh","year":"2021","journal-title":"Crit Care Res Pract"},{"key":"2025121411300477000_12.11.e064060.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2008.10.012"},{"key":"2025121411300477000_12.11.e064060.22","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(86)90046-2"},{"key":"2025121411300477000_12.11.e064060.23","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.Ed000142"},{"key":"2025121411300477000_12.11.e064060.24","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-017-0315-7"},{"key":"2025121411300477000_12.11.e064060.25","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.200077"},{"key":"2025121411300477000_12.11.e064060.26","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1007\/s00134-019-05801-z","article-title":"Vasopressor therapy in critically ill patients with shock","volume":"45","author":"Russell","year":"2019","journal-title":"Intensive Care Med"},{"key":"2025121411300477000_12.11.e064060.27","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/j.jcrc.2013.05.021","article-title":"Oral midodrine treatment accelerates the liberation of intensive care unit patients from intravenous vasopressor infusions","volume":"28","author":"Levine","year":"2013","journal-title":"J Crit Care"},{"key":"2025121411300477000_12.11.e064060.28","doi-asserted-by":"crossref","DOI":"10.1378\/chest.1990326","article-title":"Safety of oral midodrine as a method of weaning from intravenous vasoactive medication in the medical intensive care unit","volume":"146","author":"Cardenas-Garcia","year":"2014","journal-title":"Chest"},{"key":"2025121411300477000_12.11.e064060.29","doi-asserted-by":"crossref","unstructured":"Bethannie DD , Kenneth I . Midodrine use in intensive care unit patients recovering from septic shock. SRCCC 2018;6.doi:10.12746\/swrccc.v6i26.509","DOI":"10.12746\/swrccc.v6i26.509"},{"key":"2025121411300477000_12.11.e064060.30","doi-asserted-by":"crossref","DOI":"10.1097\/01.ccm.0000648268.34861.39","article-title":"1590: impact of adjuvant use of midodrine in septic patients receiving vasopressors in the ICU setting","volume":"48","author":"Hailu","year":"2020","journal-title":"Crit Care Med"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-064060","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T19:30:16Z","timestamp":1765740616000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-064060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11]]},"references-count":30,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,23]]},"published-print":{"date-parts":[[2022,11]]}},"alternative-id":["10.1136\/bmjopen-2022-064060"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-064060","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2022,11]]}}}