翻译：任文鑫 编辑：冯玉蓉 审校：曹莹
结果：在2012年10月至2019年6月期间，136名参与者被随机抽样，其中132人接受了分配的干预，并纳入了分析(修改后的意向治疗方法)。米多君组和安慰剂组的升压药停药时间无差异(中位数[IQR], 23.5 [10–54] vs 22.5 [10.4–40] h; 差值为1 h; 95% CI −10.4~12.3 h; p=0.62)。次要指标未观察到差异。使用米多君后，心动过缓的发生率更高(5 [7.6%] vs 0 [0%], p=0.02)。
原始文献来源：Peter S, Matthew HA, Maria DP, et al. Efect 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.Intensive Care Med. 2020 Sep 3. doi: 10.1007/s00134-020-06216-x.
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
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 (modifed intention-to-treat approach). Time to vasopressor discontinuation was not diferent between midodrine and placebo groups (median [IQR], 23.5 [10–54] vs 22.5
[10.4–40] h; diference, 1 h; 95% CI−10.4 to 12.3 h; p=0.62). No diferences in secondary endpoints were observed. Bradycardia occurred more often after midodrine administration (5 [7.6%] vs 0 [0%], p=0.02).
Conclusion: Midodrine did not accelerate liberation from intravenous vasopressors and was not efective for the treatment of hypotension in critically ill patients.