scholarly journals Methylene blue? Therapeutic Alternative in the Management of Septic Shock Refractory to Norepnephrine

2020 ◽  
Keyword(s):  
Septic Shock ◽  
Methylene Blue ◽  
Therapeutic Alternative ◽  
Norepinephrine Infusion ◽  
Hemodynamic Deterioration ◽  
Cord Injury ◽  
Distributive Shock ◽  
Refractory Septic Shock ◽  
High Doses ◽  
Vasoplegic Syndrome

Introduction: Methylene blue is receiving special interest in perioperative and intensive care of patients with distributive shock due to its ability to block the action of nitric oxide and to antagonize deep vasodilation. Objective: The objective is to illustrate the use of the methylene blue, summarizing the perioperative management of a case with secondary vasoplegic syndrome due to a norepinephrine refractory septic shock and the response to methylene blue, reviewing the latest evidence of this therapeutic alternative. In practice:We describe the case of a 60-year-old man, paraplegic, with septic shock due to a long evolution decubitus pressure ulcer. After two hours of surgery, the patient remained with hemodynamic deterioration despite high doses of vasopressin (3 IU/hour) and norepinephrine (2 µg/kg /min), therefore methylene blue was administered with two intravenous bolus doses of 50 mg without adverse effects. After half an hour hemodynamic improvement was evidenced, allowing to decrease norepinephrine infusion and normalizing blood pressure. Finally, debridement of necrotic tissue, amputation and disarticulation of left coxofemoral joint was performed with subsequent transfer to the ICU and discharge to the spinal cord injury ward twenty eight days later. Conclusions: As it has been demonstrated in our patient, methylene blue is a therapeutic alternative to manage patients with persistent hypotension despite the use of various vasopressors during the management of vasoplegic syndrome secondary to septic shock.

scholarly journals METHYLENE BLUE IN REFRACTORY SEPTIC SHOCK

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A2558
Author(s):  
Mouhanned Eliliwi ◽  
Jennifer Meyfeldt ◽  
Stephanie Hart ◽  
Eliot Friedman
Keyword(s):  
Septic Shock ◽  
Methylene Blue ◽  
Refractory Septic Shock

1992: METHYLENE BLUE IN REFRACTORY SEPTIC SHOCK: LOSING OUR WAY FOR THE SAKE OF A MAP?

2016 ◽  
Vol 44 (12) ◽  
pp. 573-573
Author(s):  
Cyril Varghese ◽  
Erin Demartino ◽  
Egan Ashley ◽  
Jaclyn Jacobi ◽  
Daniels Lisa ◽  
...  
Keyword(s):  
Septic Shock ◽  
Methylene Blue ◽  
Refractory Septic Shock

scholarly journals Methylene Blue for Vasoplegic Syndrome

2017 ◽  
Vol 20 (5) ◽  
pp. 234 ◽  
Author(s):  
Alexander T. Booth ◽  
Patrick D. Melmer ◽  
Benjamin Tribble ◽  
J. Hunter Mehaffey ◽  
Curt Tribble
Keyword(s):  
Methylene Blue ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Side Effects ◽  
Vasodilatory Shock ◽  
Prospective Data ◽  
Dosing Strategies ◽  
High Doses ◽  
Vasoactive Medications ◽  
Vasoplegic Syndrome

Vasoplegic syndrome is a form of vasodilatory shock that occurs frequently in patients who undergo cardiac surgery requiring cardiopulmonary bypass (CBP). Treatment often demands high doses of vasopressors over sustained periods for hypotension that can be refractory to standard vasoactive medications. Furthermore, the development of vasoplegia greatly contributes to morbidity and mortality following cardiac surgery. Methylene blue (MB) has become a popular therapy for cardiac vasoplegia despite a paucity of prospective data to direct its use. Therefore, the aim of this study was to review available data regarding mechanisms, dosing strategies, and side effects of MB, with a focus on its applications for vasoplegia in cardiac surgery.

scholarly journals Refractory Septic Shock (Part 2)

2021 ◽  
Vol 18 (3) ◽  
pp. 79-86
Author(s):  
L. L. Plotkin
Keyword(s):  
Septic Shock ◽  
Methylene Blue ◽  
Intensive Care ◽  
Intensive Therapy ◽  
Vitamin B ◽  
Vasopressor Therapy ◽  
Short Term ◽  
Refractory Shock ◽  
Short Term Mortality ◽  
Refractory Septic Shock

Refractory shock is the shock that does not respond to vasopressor therapy. Refractory shock with a short-term mortality rate of more than 50% is diagnosed in 6-7% of critically ill patients. There is an objective need to Investigate methods of intensive therapy for refractory septic shock.The objective of the study: to analyze literature data on the intensive care of refractory septic shock.Results. The second part of the article analyzes 37 studies, both Russian and foreign ones devoted to the intensive care of refractory shock. At present, based on the analysis of the publication, it is impossible to draw reasonable conclusions about the advantage of one or another method of intensive therapy for refractory shock (veno-venous hemofiltration, the use of angiotensin II and vasopressin, as well as methylene blue, vitamin B12, ECMO) over basic therapy.

scholarly journals The Effects of Methylene Blue on Hemodynamic Parameters and Cytokine Levels in Refractory Septic Shock

2005 ◽  
Vol 20 (2) ◽  
pp. 123 ◽  
Author(s):  
Byung-Kyu Park ◽  
Tae-Sun Shim ◽  
Chae-Man Lim ◽  
Sang-Do Lee ◽  
Woo-Sung Kim ◽  
...  
Keyword(s):  
Septic Shock ◽  
Methylene Blue ◽  
Hemodynamic Parameters ◽  
Cytokine Levels ◽  
Refractory Septic Shock

scholarly journals The additional use of methylene blue has a decatecholaminisation effect on cardiac vasoplegic syndrome after cardiac surgery

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Walter Petermichl ◽  
Michael Gruber ◽  
Ina Schoeller ◽  
Kwahle Allouch ◽  
Bernhard M. Graf ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Cardiac Surgery ◽  
Standard Treatment ◽  
Ventricular Dysfunction ◽  
Systemic Disease ◽  
High Dose ◽  
High Doses ◽  
Severe Systemic Disease ◽  
Vasoplegic Syndrome ◽  
Adult Cardiac Surgery

Abstract Background Postoperative vasoplegia with minimal responsiveness to vasopressors is common after cardiac surgery. Called cardiac vasoplegic syndrome (CVS), it is caused by multiple factors. Treating CVS involves a high dose of fluids and catecholamines, however high doses of catecholamines and fluids are associated with serious side effects. There is evidence that new therapeutic strategies can lead to a reduction in norepinephrine doses and mortality in CVS. Specifically, the use of non-adrenergic vasopressors such as methylene blue (MB) can be beneficial. Methods We retrospectively analyzed the electronic records of 8716 adult cardiac surgery patients from November 2008 to December 2016. Medication, hemodynamic and outcome parameter data were analyzed for CVS until discharge. We determined CVS according to the following parameters: a postoperative onset of ≤24 h, a reduced mean arterial pressure (MAP) of < 70 mmHg, a dose of norepinephrine ≥0.8 mg*h− 1 and a continuously increasing need for catecholamine, without ventricular dysfunction. Results We identified 513 patients with CVS. Perioperative risk factors were higher in patients treated with methylene blue (MB). Before MB administration patients had a significantly higher dose of norepinephrine, and MAP increased after MB administration. Norepinephrine could be reduced after MB administration and MAP remained stable at the same level even after the reduction of norepinephrine. Conclusions CVS patients have a severe systemic disease accompanied by significant operative stress and a high catecholamine requirement. The administration of MB in addition to standard treatment for CVS in the first 24 h was accompanied by an increase in MAP followed by a decrease in vasopressor requirement, indicating that early MB administration can be beneficial.

scholarly journals Prolonged methylene blue infusion in refractory septic shock: a case report

2011 ◽  
Vol 58 (4) ◽  
pp. 401-405 ◽  
Author(s):  
Tristan C. Dumbarton ◽  
Samuel Minor ◽  
Colin K. Yeung ◽  
Robert Green
Keyword(s):  
Septic Shock ◽  
Methylene Blue ◽  
Case Report ◽  
Refractory Septic Shock

Methylene blue versus vasopressin analog for refractory septic shock in the preterm neonate: A randomized controlled trial

2021 ◽  
pp. 1-9
Author(s):  
R. Ismail ◽  
H. Awad ◽  
R. Allam ◽  
O. Youssef ◽  
M. Ibrahim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Septic Shock ◽  
Methylene Blue ◽  
Randomized Controlled Trial ◽  
Side Effects ◽  
Preterm Neonate ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Arterial Blood ◽  
Refractory Septic Shock

BACKGROUND: Refractory septic shock in neonates is still associated with high mortality, necessitating an alternative therapy, despite all currently available treatments. This study aims to assess the vasopressor effect of methylene blue (MB) in comparison to terlipressin (TP) as adjuvant therapy for refractory septic shock in the preterm neonate. METHODS: A double-blinded randomized controlled trial was conducted in the Neonatal Intensive Care Units at Ain Shams University, Egypt. Thirty preterm neonates with refractory septic shock were randomized to receive either MB or TP as an adjuvant to conventional therapy. Both MB and TP were administered as an intravenous loading dose followed by continuous intravenous infusion. The hemodynamic variables, functional echocardiographic variables, and oxidant stress marker were assessed over a 24 h period together with the side effects of MB. RESULTS: MB causes significant improvement in mean arterial blood pressure with a significant decrease of the norepinephrine requirements (1.15±0.21μm/kg/min at baseline vs. 0.55±0.15μm/kg/min at 24 h). MB infusion causes an increase of the pulmonary pressure (44.73±8.53 mmHg at baseline vs. 47.27±7.91 mmHg after 24 h) without affecting the cardiac output. Serum malonaldehyde decreased from 5.45±1.30 nmol/mL at baseline to 4.40±0.90 nmol/mL at 24 h in the MB group. CONCLUSION: Administration of MB to preterm infants with refractory septic shock showed rapid increases in systemic vascular resistance and arterial blood pressure with minimal side effects.

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