title: Study Design and Rationale of "A Multicenter, Open-Labeled, Randomized Controlled Trial Comparing MIdazolam Versus MOrphine in Acute Pulmonary Edema": MIMO Trial.
abstract: OBJECTIVE
  Morphine has been used for several decades in cases of acute pulmonary edema (APE) due to the anxiolytic and vasodilatory properties of the drug. The non-specific depression of the central nervous system is probably the most significant factor for the changes in hemodynamics in APE. Retrospective studies have shown both negative and neutral effects in patients with APE and therefore some authors have suggested benzodiazepines as an alternative treatment. The use of intravenous morphine in the treatment of APE remains controversial.
  
  
  METHODS
  The MIdazolan versus MOrphine in APE trial (MIMO) is a multicenter, prospective, open-label, randomized study designed to evaluate the efficacy and safety of morphine in patients with APE. The MIMO trial will evaluate as a primary endpoint whether intravenous morphine administration improves clinical outcomes defined as in-hospital mortality. Secondary endpoint evaluation will be mechanical ventilation, cardiopulmonary resuscitation, intensive care unit admission rate, intensive care unit length of stay, and hospitalization length.
  
  
  CONCLUSIONS
  In the emergency department, morphine is still used for APE in spite of poor scientific background data. The data from the MIMO trial will establish the effect-and especially the risk-when using morphine for APE.
authors.affiliation: Department of Cardiology, Hospital Universitario de Canarias, Ofra s/n La Cuesta, 38320, Santa Cruz de Tenerife, Spain. adrvdg@hotmail.com.|Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain. adrvdg@hotmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Dominguez-Rodriguez
authors.affiliation: Hospital Universitario de Canarias, Servicio de Urgencias, Santa Cruz de Tenerife, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Burillo-Putze
authors.affiliation: Department of Pharmacology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
authors.forename: Maria Del Mar
authors.initials: MDM
authors.lastname: Garcia-Saiz
authors.affiliation: Department of Pharmacology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Aldea-Perona
authors.affiliation: Department of Pharmacology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
authors.forename: Magali González-Colaço
authors.initials: MG
authors.lastname: Harmand
authors.affiliation: Emergency Department, Hospital Clínic, and Institut de Recerca Biomàdica August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Mirò
authors.affiliation: Departamento de Ciencias Médicas Básicas (Unidad de Fisiología), Universidad de La Laguna, Santa Cruz de Tenerife, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Abreu-Gonzalez
mesh_terms: D000208:Acute Disease; D061605:Administration, Intravenous; D014151:Anti-Anxiety Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016887:Cardiopulmonary Resuscitation; D002985:Clinical Protocols; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D011654:Pulmonary Edema / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D012107:Research Design; D012121:Respiration, Artificial; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014151:Anti-Anxiety Agents; D014665:Vasodilator Agents; D009020:Morphine; D008874:Midazolam
keywords: Benzodiazepines; Heart Failure; Morphine; Mortality